Re-irradiation with and without bevacizumab as salvage therapy for recurrent or progressive high-grade gliomas
Re-irradiation with and without bevacizumab as salvage therapy for recurrent or progressive high-grade gliomas
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DOI：
10.1007/s11060-013-1044-3
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发表时间：
2013-03-01
影响因子：
3.9
通讯作者：
Plasswilm, Ludwig
中科院分区：
文献类型：
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作者：
Hundsberger, Thomas;Bruegge, Detlef;Plasswilm, Ludwig
复发性高级别胶质瘤的最佳治疗方法尚不清楚，护理标准也不存在。贝伐单抗联合再照射是一种选择。回顾性地，我们分析了一组接受常规3d适形或强化调制放疗（IMRT）再照射的重度预处理的复发性hgg患者（n = 14）。其中10例接受再照射联合贝伐单抗。研究人群包括8例GBMs和6例间变性胶质瘤。所有患者之前都接受过一线放疗，包括7例使用替莫唑胺放化疗的患者。无禁禁症的患者在再照射前开始两次输注贝伐单抗（每隔一周10 mg/kg体重），并继续通过再照射直到进展。患者年龄中位数为45岁，Karnofsky表现量表中位数为70。再照射中位剂量为41.6 Gy [39 ~ 55 Gy]。中位物理累积辐射剂量为101.6 Gy [65-110.4 Gy]。根据临床和RANO标准，再照射后的中位PFS为5.1个月[1.6-17.4]。再照射的中位OS为9.0个月[6.4-17.8]。我们在一名患者中发现了由于先进的影像学所致的放射性坏死。贝伐单抗的其他毒性是意料之中的，并可归因于其众所周知的副作用。这项回顾性研究提供了常规3d适形再照射和IMRT联合贝伐单抗治疗复发的高级胶质瘤的额外可行性和安全性数据。
The optimal treatment for recurrent high-grade gliomas is unknown and a standard of care does not exist. Re-irradiation with concomitant bevacizumab represents an option. Retrospectively, we analyzed a cohort of heavily pretreated patients (n = 14) with relapsing HGGs who underwent re-irradiation with conventional 3D-conformal or intensified modulated radiotherapy (IMRT). Ten of them received re-irradiation in combination with bevacizumab. The study population consisted of eight GBMs and six anaplastic gliomas. All patients had previously undergone irradiation for first-line therapy, including seven patients with radiochemotherapy with temozolomide. Patients without contraindications started with two infusions of bevacizumab (10 mg/kg of body weight every other week) prior to re-irradiation and continued through re-irradiation until progression. The median patient age was 45 years with a median Karnofsky performance scale of 70. The median dose of re-irradiation was 41.6 Gy [39-55 Gy]. The median physical cumulative radiation dose was 101.6 Gy [65-110.4 Gy]. The median PFS from re-irradiation was 5.1 months [1.6-17.4] based on clinical and RANO criteria. Median OS from re-irradiation was 9.0 months [6.4-17.8]. We detected radionecrosis due to advanced imaging in one patient. Other toxicities were expected and attributable well known side effects of bevacizumab. This retrospective study provides additional feasibility and safety data of conventional 3D-conformal re-irradiation and IMRT in combination with bevacizumab in relapsing high-grade gliomas.