Patterns of relapse in patients with high grade glioma receiving combined treatments including stereotactic re-irradiation for a first relapse.
OBJECTIVE
Bevacizumab and stereotactic treatment are efficient combined or alone in relapse glioma. However, patterns of relapse after this kind of salvage treatment have never been studied. The purpose of this unicentric retrospective analysis was to assess and understand the patterns of relapse of high grade glioma treated with stereotactic radiation, with or without bevacizumab.


METHODS
Twenty patients with high grade glioma relapse received a stereotactic radiation; among them two patients received temozolomide and eight patients received bevacizumab; among the latter, four received also irinotecan. We matched the stereotactic radiation treatment planning scan with the images of the first treatment and of the second relapse in order to determine the patterns of failure and associate dosimetric profile.


RESULTS
For the total population, median follow-up from the first diagnosis and relapse were 46.1 and 17.6 months, respectively. Among the 13 patients who relapsed, ten did not receive chemotherapy and three received it (P<0.05), two received temozolomide and one bevacizumab. Patients who received bevacizumab had no "out-of-field" recurrences. Among the 32 irradiated relapses, 15 were "in-field" recurrences; among them two were treated with bevacizumab and 13 were not (P<0.05). For the 32 lesions, a favourable prognostic factor of control was the association of a high-dose of irradiation and the use of bevacizumab.


CONCLUSIONS
For patients with relapsed high grade glioma, local control was higher with combined bevacizumab and high-dose stereotactic radiation.
Radiotherapy department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France; Radiobiology laboratory, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France.
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Antoni
Radiotherapy department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France.
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Jastaniah
Radiation oncology department, university of Rochester medical center, 601, Elmwood Avenue/Box 647, 14642 Rochester, NY, USA.
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Haoming
Neurology department, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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Gaultier
Neurology department, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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Ahle
Radiotherapy department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France.
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Couchot
Radiotherapy department, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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Atlani
Medical oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France.
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Schott
Radiotherapy department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France.
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Clavier
Neurosurgery department, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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Srour
Neurosurgery department, CHU Hautepierre, 1, avenue Molière, 67100 Strasbourg, France.
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Chaussemy
Radiotherapy department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France; Radiobiology laboratory, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67000 Strasbourg cedex, France. Electronic address: gnoel@strasbourg.unicancer.fr.
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Noël
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D000069475:Re-Irradiation; D012189:Retrospective Studies; D000077204:Temozolomide
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D000068258:Bevacizumab; D000077146:Irinotecan; D003606:Dacarbazine; D002166:Camptothecin; D000077204:Temozolomide
Bevacizumab; Bévacizumab; Gliome de haut grade; High grade glioma; Irradiation en conditions stéréotaxiques; Pattern of relapse; Rechute; Relapse; Site de rechute; Stereotactic radiation