Re-irradiation strategies in combination with bevacizumab for recurrent malignant glioma.
The place of bevacizumab (BEV) in salvage re-irradiation (Re-RT) settings of malignant glioma is poorly defined. In the current study risk/benefit profiles of two BEV-based Re-RT protocols were analyzed and compared with that of salvage BEV plus irinotecan (BEV/IRI). According to interdisciplinary tumor board recommendations, patients were assigned to one of three BEV-based treatment protocols: (1) BEV/IRI, (2) Re-RT (36 Gy/18 fx) with concomitant BEV (Re-RT/BEV), and (3) Re-RT with concomitant/maintenance BEV (Re-RT/BEV→BEV). Prognostic factors were obtained from proportional hazards models. Adverse events were classified according to the NCI CTCAE, v4.0. 105 consecutive patients were enrolled from 08/2008 to 05/2014. Patients undergoing Re-RT experienced longer time intervals from initial diagnosis to BEV treatment (median: 22.0 months vs. 13.7 months, p = 0.001); those assigned to Re-RT/BEV→BEV rated better on the performance scale (median KPSREC: 90 vs. 70, p = 0.013). Post-recurrence survival after BEV-based treatment (PRS) was longest after Re-RT/BEV→BEV (median: 13.1 months vs. 8 months, p = 0.006). PRS after Re-RT/BEV and BEV/IRI was similar. Multivariately, higher KPSRECand Re-RT/BEV→BEV were associated with longer PRS. Treatment toxicity did not differ among groups. Re-RT/BEV→BEV is safe, feasible and effective and deserves further prospective evaluation.
Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Oliver
O
Schnell
Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Jun
J
Thorsteinsdottir
Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Daniel Felix
DF
Fleischmann
Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Markus
M
Lenski
MVZ Onkologie im Elisenhof, Prielmayerstr. 1, 80335, Munich, Germany.
Wolfgang
W
Abenhardt
Center for Neuropathology and Prion Research, LMU Munich, Feodor-Lynen-Str. 20, 81377, Munich, Germany.
Armin
A
Giese
Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Jörg-Christian
JC
Tonn
Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Claus
C
Belka
Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Friedrich Wilhelm
FW
Kreth
Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. maximilian.niyazi@med.uni-muenchen.de.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. maximilian.niyazi@med.uni-muenchen.de.
Maximilian
M
Niyazi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy; D000069475:Re-Irradiation / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D000068258:Bevacizumab
Bevacizumab; Glioblastoma; Radiotherapy; Re-irradiation; Recurrent glioma