title: Hypofractionated stereotactic radiotherapy in combination with bevacizumab or fotemustine for patients with progressive malignant gliomas.
abstract: To evaluate the efficacy of hypofractionated stereotactic radiotherapy performed as reirradiation in combination with fotemustine or bevacizumab as salvage treatment in patients with recurrent malignant glioma. Between May 2006 and December 2013, 54 patients with recurrent malignant glioma received hypofractionated stereotactic radiotherapy (HSRT, 25 Gy in 5-Gy fractions) plus either fotemustine or bevacizumab at University of Rome Sapienza, Sant'Andrea Hospital. All patients had Karnofsky performance score (KPS) ≥ 60 and were previously treated with standard chemoradiotherapy. Forty-two patients had a GBM and 12 patients had an anaplastic astrocytoma (AA). The median overall survival (OS) time and 12-month OS rates after HSRT was 11 months and 30 % for patients treated with HSRT plus bevacizumab and 8.3 months and 5 % for those treated with HSRT plus fotemustine (p = 0.01). Median PFS times were 4 and 6 months for patients treated with HSRT plus fotemustine or bevacizumab, respectively (p = 0.01). KPS > 70 (p = 0.04), AA histology, and the treatment with bevacizumab were independent favourable prognostic factors for OS. In general, both treatments were well tolerated with relatively low treatment-related toxicity. HSRT combined with bevacizumab or fotemustine may represent a feasible treatment option for patients with progressive malignant gliomas, although most of the tumors recur in a few months. Efficacy of bevacizumab or alkylating agents in combination with different radiation schedules needs to be evaluated in prospective studies.
authors.affiliation: Unit of Radiation Oncology, Sant'Andrea Hospital, University Sapienza, Rome, Italy, gminniti@ospedalesantandrea.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.forename: Teresa
authors.initials: T
authors.lastname: Falco
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lanzetta
authors.forename: Paola
authors.initials: P
authors.lastname: Caporello
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D005910:Glioma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000627:therapeutic use*; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; D000068258:Bevacizumab; C054368:fotemustine