. 2021 Jul;163(7):1921-1934.

doi: 10.1007/s00701-021-04794-3. Epub 2021 Apr 2.

Radiotherapy versus combination radiotherapy-bevacizumab for the treatment of recurrent high-grade glioma: a systematic review

Daniel P Kulinich^{1

2}, John P Sheppard^{1

2}, Thien Nguyen^{1

2}, Aditya M Kondajji^{1

2}, Ansley Unterberger^{1

2}, Courtney Duong^{1

2}, Adam Enomoto^{1

2}, Kunal Patel^{1

2}, Isaac Yang^{3

4

5

6

7

8

9}

Affiliations

¹ Departments of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Suite 562, Los Angeles, CA, USA.
² David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Departments of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Suite 562, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁴ David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁵ Departments of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁶ Departments of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁷ Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁸ Los Angeles Biomedical Research Institute, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁹ Harbor-UCLA Medical Center, West Carson, CA, USA. iyang@mednet.ucla.edu.

PMID: 33796887
PMCID: PMC8195900
DOI: 10.1007/s00701-021-04794-3

Radiotherapy versus combination radiotherapy-bevacizumab for the treatment of recurrent high-grade glioma: a systematic review

Daniel P Kulinich et al. Acta Neurochir (Wien). 2021 Jul.

. 2021 Jul;163(7):1921-1934.

doi: 10.1007/s00701-021-04794-3. Epub 2021 Apr 2.

Authors

Affiliations

¹ Departments of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Suite 562, Los Angeles, CA, USA.
² David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Departments of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, Suite 562, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁴ David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁵ Departments of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁶ Departments of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁷ Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁸ Los Angeles Biomedical Research Institute, Los Angeles, CA, USA. iyang@mednet.ucla.edu.
⁹ Harbor-UCLA Medical Center, West Carson, CA, USA. iyang@mednet.ucla.edu.

PMID: 33796887
PMCID: PMC8195900
DOI: 10.1007/s00701-021-04794-3

Abstract

Background: High-grade gliomas (HGG) comprise the most common primary adult brain cancers and universally recur. Combination of re-irradiation therapy (reRT) and bevacizumab (BVZ) therapy for recurrent HGG is common, but its reported efficacy is mixed.

Objective: To assess clinical outcomes after reRT ± BVZ in recurrent HGG patients receiving stereotactic radiosurgery (SRS), hypofractionated radiosurgery (HFSRT), or fully fractionated radiotherapy (FFRT).

Methods: We performed a systematic review of PubMed, Web of Science, Scopus, Embase, and Cochrane databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified studies reporting outcomes for patients with recurrent HGG treated via reRT ± BVZ. Cohorts were stratified by BVZ treatment status and re-irradiation modality (SRS, HFSRT, and FFRT). Outcome variables were overall survival (OS), progression-free survival (PFS), and radiation necrosis (RN).

Results: Data on 1399 patients was analyzed, with 954 patients receiving reRT alone and 445 patients receiving reRT + BVZ. All patients initially underwent standard-of-care therapy for their primary HGG. In a multivariate analysis that adjusted for median patient age, WHO grade, RT dosing, reRT fractionation regimen, time between primary and re-irradiation, and re-irradiation target volume, BVZ therapy was associated with significantly improved OS (2.51, 95% CI [0.11, 4.92] months, P = .041) but no significant improvement in PFS (1.40, 95% CI [- 0.36, 3.18] months, P = .099). Patients receiving BVZ also had significantly lower rates of RN (2.2% vs 6.5%, P < .001).

Conclusions: Combination of reRT + BVZ may improve OS and reduce RN rates in recurrent HGG, but further controlled studies are needed to confirm these effects.

Keywords: Astrocytoma; Bevacizumab; Glioblastoma; Glioma; Radiosurgery; Radiotherapy; Recurrent.

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Conflict of interest statement

The authors declare no conflict of interest.

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Radiotherapy versus combination radiotherapy-bevacizumab for the treatment of recurrent high-grade glioma: a systematic review

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Radiotherapy versus combination radiotherapy-bevacizumab for the treatment of recurrent high-grade glioma: a systematic review

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