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. 2015 May-Jun;20(3):231-8.
doi: 10.1016/j.rpor.2015.01.004. Epub 2015 Feb 20.

Fractionated stereotactic radiotherapy plus bevacizumab after response to bevacizumab plus irinotecan as a rescue treatment for high-grade gliomas

Antonio José Conde-Moreno  1 , Raquel García-Gómez  1 , María Albert-Antequera  1 , Piedad Almendros-Blanco  1 , Ramón De Las Peñas-Bataller  1 , Verónica González-Vidal  1 , José Luis López-Torrecilla  1 , Carlos Ferrer-Albiach  1
Affiliations

Fractionated stereotactic radiotherapy plus bevacizumab after response to bevacizumab plus irinotecan as a rescue treatment for high-grade gliomas

Antonio José Conde-Moreno et al. Rep Pract Oncol Radiother. 2015 May-Jun.

Abstract

Aim: To evaluate the possibility of implementing a new scheme of rescue treatment after relapse or progression of high-grade glioma (HGG) treated at the first-line with bevacizumab and irinotecan (BVZ+CPT11), evaluating the response and toxicity of associating BVZ and fractionated stereotactic radiotherapy (BVZ+FSRT).

Materials and methods: We retrospectively analysed data from 59 patients with relapse of HGG. Nine patients with HGG relapse after treatment using the Stupp protocol that were treated with BVZ+CPT11 for progression between July 2007 and August 2012, after which the response was assessed according to the Revised Assessment in Neuro-Oncology (RANO) criteria. BVZ was administered at a dose of 10 mg/kg and FSRT up to a prescribed dose of 30 Gy, 500 cGy per fraction, three days a week. The median follow-up was 38 months.

Results: The treatment was well-tolerated by all patients. The response after nuclear magnetic resonance imaging (MRI) at 3-6 months was progression in two patients, stable disease in four, and three patients had a partial response. The median overall survival (OS) from diagnosis until death or the last control was 36.8 months. The median progression-free survival (PFS) was 10.8 months. The results from tumour sub-group analysis indicated that the PFS was not statistically significant although it seemed that it was higher in grade-III. The OS was higher in grade-III gliomas.

Conclusions: The combination of BVZ+FSRT as a second-line HGG relapse rescue treatment is well-tolerated and seems to offer promising results. We believe that multi-centre prospective studies are needed to determine the long-term efficacy and toxicity of this therapeutic approach.

Keywords: ASCO, American Society of Clinical Oncology; BVZ, bevacizumab; Bevacizumab; CAT, computed axial tomography; CI, confidence interval; CPT11, irinotecan; CR, complete response; CTCAE, common terminology criteria for adverse events; FLAIR, fluid-attenuated inversion recovery; FSRT, fractionated stereotactic radiotherapy; Fractionated stereotactic radiotherapy; GTV, gross tumour volume; HGG, high-grade glioma; HR, hazard ratio; High-grade glioma; KPS, Karnofsky Performance Scale; MGMT, O-6-methylguanine-DNA methyltransferase; MRI, magnetic resonance imaging; NA, not applicable; OS, overall survival; PD, progressive disease; PET, positron emission tomography; PFS, progression-free survival; PR, partial response; PTV, planning target volume; RANO, revised Assessment in Neuro-Oncology; Rescue treatment; SD, stable disease; SEOM, Sociedad Española de Oncología Médica; SRS, stereotactic radiosurgery; TMZ, temozolomide; VEGF, vascular endothelial growth factor.

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Figures

Fig. 1
Fig. 1
Overall survival from high-grade glioma diagnosis until death.
Fig. 2
Fig. 2
Progression-free survival after bevacizumab and fractionated stereotactic radiotherapy treatment.
Fig. 3
Fig. 3
Progression-free survival by tumour subgroups.
Fig. 4
Fig. 4
Overall survival by tumour subgroup after BVZ+FSRT treatment.
Fig. 5
Fig. 5
Overall survival by tumour subgroup since diagnosis.
See this image and copyright information in PMC

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