Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial.

Abstract

PURPOSE:

Virtually all patients with malignant glioma (MG) eventually recur. This study evaluates the safety of concurrent stereotactic radiosurgery (SRS) and bevacizumab (BVZ), an antiangiogenic agent, in treatment of recurrent MG.

METHODS AND MATERIALS:

Fifteen patients with recurrent MG, treated at initial diagnosis with surgery and adjuvant radiation therapy/temozolomide and then at least 1 salvage chemotherapy regimen, were enrolled in this prospective trial. Lesions <3 cm in diameter were treated in a single fraction, whereas those 3 to 5 cm in diameter received 5 5-Gy fractions. BVZ was administered immediately before SRS and 2 weeks later. Neurocognitive testing (Mini-Mental Status Exam, Trail Making Test A/B), Functional Assessment of Cancer Therapy-Brain (FACT-Br) quality-of-life assessment, physical exam, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were performed immediately before SRS and 1 week and 2 months following completion of SRS. The primary endpoint was central nervous system (CNS) toxicity. Secondary endpoints included survival, quality of life, microvascular properties as measured by DCE-MRI, steroid usage, and performance status.

RESULTS:

One grade 3 (severe headache) and 2 grade 2 CNS toxicities were observed. No patients experienced grade 4 to 5 toxicity or intracranial hemorrhage. Neurocognition, quality of life, and Karnofsky performance status did not change significantly with treatment. DCE-MRI results suggest a significant decline in tumor perfusion and permeability 1 week after SRS and further decline by 2 months.

CONCLUSIONS:

Treatment of recurrent MG with concurrent SRS and BVZ was not associated with excessive toxicity in this prospective trial. A randomized trial of concurrent SRS/BVZ versus conventional salvage therapy is needed to establish the efficacy of this approach.

• Authors: Alvin R Cabrera, Kyle C Cuneo, Annick Desjardins, John H Sampson, Frances McSherry, James E Herndon 2nd, Katherine B Peters, Karen Allen, Jenny K Hoang, Zheng Chang, Oana Craciunescu, James J Vredenburgh, Henry S Friedman, John P Kirkpatrick
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 86 Issue 5 Pg. 873-9 (Aug 01 2013) ISSN: 1879-355X [Electronic] United States
• PMID: 23725997 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Bevacizumab

Topics

• Adult
• Aged
• Angiogenesis Inhibitors (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bevacizumab
• Brain Neoplasms (pathology, therapy)
• Combined Modality Therapy (methods)
• Female
• Glioma (pathology, therapy)
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (pathology, therapy)
• Prospective Studies
• Quality of Life
• Radiosurgery (adverse effects, methods)
• Radiotherapy Dosage
• Tumor Burden