Irradiation and bevacizumab in high-grade glioma retreatment settings

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Maximilian Niyazi - , Ludwig Maximilian University of Munich (Author)
  • Ute Ganswindt - , Ludwig Maximilian University of Munich (Author)
  • Silke Birgit Schwarz - , Ludwig Maximilian University of Munich (Author)
  • Friedrich Wilhelm Kreth - , Ludwig Maximilian University of Munich (Author)
  • Jörg Christian Tonn - , Ludwig Maximilian University of Munich (Author)
  • Julia Geisler - , Ludwig Maximilian University of Munich (Author)
  • Christian La Fougère - , Ludwig Maximilian University of Munich (Author)
  • Lorenz Ertl - , Ludwig Maximilian University of Munich (Author)
  • Jennifer Linn - , Hospital of the Ludwig-Maximilians-University (LMU) Munich, Ludwig Maximilian University of Munich (Author)
  • Axel Siefert - , Ludwig Maximilian University of Munich (Author)
  • Claus Belka - , Ludwig Maximilian University of Munich (Author)

Abstract

Purpose: Reirradiation is a treatment option for recurrent high-grade glioma with proven but limited effectiveness. Therapies directed against vascular endothelial growth factor have been shown to exert certain efficacy in combination with chemotherapy and have been safely tested in combination with radiotherapy in a small cohort of patients. To study the feasibility of reirradiation combined with bevacizumab treatment, the toxicity and treatment outcomes of this approach were analyzed retrospectively. Patients and Methods: After previous treatment with standard radiotherapy (with or without temozolomide) patients with recurrent malignant glioma received bevacizumab (10 mg/kg intravenous) on Day 1 and Day 15 during radiotherapy. Maintenance therapy was selected based on individual considerations, and mainly bevacizumab- containing regimens were chosen. Patients received 36 Gy in 18 fractions. Results: The data of the medical charts of the 30 patients were analyzed retrospectively. All were irradiated in a single institution and received either bevacizumab (n = 20), no additional substance (n = 7), or temozolomide (n = 3). Reirradiation was tolerated well, regardless of the added drug. In 1 patient treated with bevacizumab, a wound dehiscence occurred. Overall survival was significantly better in patients receiving bevacizumab (p = 0.03, log-rank test). In a multivariate proportional hazards Cox model, bevacizumab, Karnovsky performance status, and World Health Organization grade at relapse turned out to be the most important predictors for overall survival. Conclusion: Reirradiation with bevacizumab is a feasible and effective treatment for patients with recurrent high-grade gliomas. A randomized trial is warranted to finally answer the question whether bevacizumab adds substantial benefit to a radiotherapeutic retreatment setting.

Details

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number1
Publication statusPublished - 1 Jan 2012
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 21030162

Keywords

Sustainable Development Goals

Keywords

  • Antiangiogenesis, Bevacizumab, Glioblastoma, Malignant glioma, Radiotherapy