Clinical Study Of Bevacizumab Combined With WBRT In The Treatment Of Brain Metastasis Of Lung Adenocarcinoma

Objective:This study aims to observe the efficacy and safety of bevacizumab combined with whole brain radiotherapy(WBRT)in the treatment of brain metastases from wild-type epidermal growth factor receptor(EGFR)lung adenocarcinoma.Methods:From June 2015 to August 2017,60 patients with brain metastases from wild-type EGFR lung adenocarcinoma were selected in the affiliated Hospital of Hebei Engineering University to make a retrospective analysis.All patients were divided into the observation group(n=30)and the control group(n=30)according to whether bevacizumab was used when receiving whole brain radiotherapy(WBRT).The clinical efficacy and prognosis were compared,and the related factors affecting intracranial progression-free survival and overall survival were analyzed.Results:1.The observation group has a higher objective response rate than the control group(90.00%vs56.67%,P=0.004),and the difference between the two groups was statistically significant.In disease control rates,there was no significant statistically difference between the two groups(96.67%vs 86.67%,P=0.161).2.The observation group has a better Peritumoral edema control rate than the control group.In the reduction of peritumoral edema volume,there was significant difference between the two groups[(174.67±8.81)cm~3 vs(111.42±21.75)cm~3,P<0.001].3.The median intracranial progression-free survival of the observation group was11 months(95%CI:1.93~20.07).The control group was 8 months(95%CI:5.41~10.59).The difference between the two groups was statistically significant(11.0 vs 8.0,P=0.035).4.The median overall survival of the observation group was 16.2 months(95%CI:10.63~21.37).The control group was 11.9 months(95%CI:8.32~13.68).There was statistically significant difference between the two groups(16.2 vs 11.9,P=0.038).5.The 1-year,2-year and 3-year overall survival rates of patients were 70.0%,36.1%and 12.6%in the observation group,which were higher than those of 43.3%,18.3%and 5.5%in the control group.The difference between the two groups was statistically significant(P=0.038).6.Multi-factor analysis showed that the combination of bevacizumab were the independent prognostic factors influencing the iPFS.Multi-factor analysis showed that maximum diameter of brain metastases,extracranial organ metastases,the combination of bevacizumab were independent prognostic factors influencing the OS.7.In the observation group,there was 1 case of epistaxis and hypertension,which can be well controlled.The acute radiation injury was mainly grade 1 to 2.There was no significant statistically difference between the two groups(P>0.05).Conclusions:1.For the patients with brain metastasis of EGFR wild type lung adenocarcinoma,bevacizumab combined with WBRT was superior to WBRT in objective response rate,edema control rate.It significantly prolonged the survival time.And the adverse reactions are tolerable.2.Multi-factor analysis showed that the combination of bevacizumab were the independent prognostic factors influencing the iPFS.Multi-factor analysis showed that maximum diameter of brain metastases,extracranial organ metastases and the combination of bevacizumab were independent prognostic factors influencing the OS.