Objective To explore the efficacy and safety of concurrent gamma knife radiosurgery and bevacizumab treatment for brain metastasis from colorectal cancer with extensive cerebral edema. Methods Five patients with brain metastasis from colorectal cancer were included in this prospective investigation from March 2013 to October 2014. Bevacizumab therapy (5 mg/kg, at 2 to 3 week intervals) was administered the next day after completion of gamma knife radiosurgery for the median treatment cycle of 4. The patients were followed up for median period of 13 months, ranged from 7 to 18 months. Results Compared with the pretreatment, the lesions decreased by median of 42.85%, ranged from 29.51%to 100%on enhanced MRI T1WI sequence, and edema area decreased by median of 86.60%, ranged from 69.03%to 97.51%on T2WI sequence during short-term follow-up period after the treatment. Clinical symptoms were improved in all the 5 patients, and the KPS increased by a median of 30, ranged from 20 to 40 scores. At last follow-up, two patients died, one progressed and the other two kept tumor progression free. No symptomatic radiation or severe bevacizumab-related adverse events occurred. Conclusion Coadministration of gamma knife radiosurgery and bevacizumab as a promising salvage treatment is safe and effective for brain metastasis from colorectal cancer with extensive cerebral edema.%目的：探讨伽玛刀同步贝伐珠单抗治疗伴广泛脑水肿的结直肠癌脑转移瘤的有效性和安全性。方法2013年3月-2014年10月期间共5例结直肠癌脑转移瘤病人纳入该前瞻性研究。所有病人在伽玛刀治疗后第2天给予贝伐珠单抗静脉滴注(5 mg/kg,每2~3周重复1次),贝伐珠单抗中位治疗周期数为4。伽玛刀和贝伐珠单抗同步治疗后随访7~18个月(中位时间13个月)。结果近期随访显示：MRI T1WI 增强序列上病灶较治疗前缩小29.51%~100%(中位数42.85%),T2WI序列上病灶水肿区域缩小69.03%~97.51%(中位数86.60%)。病人临床症状均改善,KPS评分提高20~40分(中位数30分)。随访截止时,死亡2例,疾病进展1例,肿瘤控制良好2例,且未出现放射相关并发症和严重药物副作用。结论伽玛刀同步贝伐珠单抗方案作为伴广泛脑水肿的结直肠癌脑转移瘤的挽救性治疗安全且有效。
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