open access

Vol 20, No 3 (2015)
Original research articles
Published online: 2015-05-01
Submitted: 2014-08-27
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Fractionated stereotactic radiotherapy plus bevacizumab after response to bevacizumab plus irinotecan as a rescue treatment for high-grade gliomas

Antonio José Conde-Moreno, Raquel García-Gómez, María Albert-Antequera, Piedad Almendros-Blanco, Ramón De Las Peñas-Bataller, Verónica González-Vidal, José Luis López-Torrecilla, Carlos Ferrer-Albiach
DOI: 10.1016/j.rpor.2015.01.004
·
Rep Pract Oncol Radiother 2015;20(3):231-238.

open access

Vol 20, No 3 (2015)
Original research articles
Published online: 2015-05-01
Submitted: 2014-08-27

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[[ce:hsp sp="0.25"/]]mg/kg and FSRT up to a prescribed dose of 30[[ce:hsp sp="0.25"/]]Gy, 500[[ce:hsp sp="0.25"/]]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.

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[[ce:hsp sp="0.25"/]]mg/kg and FSRT up to a prescribed dose of 30[[ce:hsp sp="0.25"/]]Gy, 500[[ce:hsp sp="0.25"/]]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.

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Keywords

HGG; BVZ; CPT11; FSRT; RANO; MRI; OS; PFS; TMZ; KPS; VEGF; PTV; CAT; GTV; SEOM; ASCO; CTCAE; PET; CI; MGMT; HR; CR; PR; SD; SRS; PD; FLAIR; NA; High-grade glioma; Rescue treatment; Bevacizumab; Fractionated stereotactic radiotherapy

About this article
Title

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

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 3 (2015)

Pages

231-238

Published online

2015-05-01

DOI

10.1016/j.rpor.2015.01.004

Bibliographic record

Rep Pract Oncol Radiother 2015;20(3):231-238.

Keywords

HGG
BVZ
CPT11
FSRT
RANO
MRI
OS
PFS
TMZ
KPS
VEGF
PTV
CAT
GTV
SEOM
ASCO
CTCAE
PET
CI
MGMT
HR
CR
PR
SD
SRS
PD
FLAIR
NA
High-grade glioma
Rescue treatment
Bevacizumab
Fractionated stereotactic radiotherapy

Authors

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

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