IRRADIATION AND BEVACIZUMAB IN HIGH-GRADE GLIOMA RETREATMENT SETTINGS
IRRADIATION AND BEVACIZUMAB IN HIGH-GRADE GLIOMA RETREATMENT SETTINGS
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DOI：
10.1016/j.ijrobp.2010.09.002
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发表时间：
2012-01-01
影响因子：
7
通讯作者：
Belka, Claus
中科院分区：
文献类型：
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作者：
Niyazi, Maximilian;Ganswindt, Ute;Belka, Claus
目的：再照射是复发性高级别胶质瘤的一种治疗选择，其有效性已被证实但有限。针对血管内皮生长因子的疗法已被证明与化疗联合发挥一定的疗效，并且已经在一小群患者中与放疗联合进行了安全测试。为了研究再放疗联合贝伐单抗治疗的可行性，回顾性分析该方法的毒性和治疗结果。 患者和方法：既往接受标准放疗（加或不加替莫唑胺）治疗后的复发性恶性胶质瘤患者在放疗期间的第1天和第15天接受贝伐单抗（10 mg/kg静脉注射）。维持治疗根据个体考虑选择，主要选择含贝伐单抗的方案。患者接受18次36Gy的照射。结果：对30例患者的病历数据进行回顾性分析。所有患者均在同一机构接受辐射，并接受贝伐单抗 (n = 20)、不使用其他物质 (n = 7) 或替莫唑胺 (n = 3)。无论添加何种药物，再照射的耐受性良好。 1 名接受贝伐珠单抗治疗的患者出现伤口裂开。接受贝伐珠单抗治疗的患者的总生存期明显更好（p = 0.03，对数秩检验）。在多变量比例风险 Cox 模型中，贝伐珠单抗、卡诺夫斯基体能状态和世界卫生组织复发分级被证明是总生存期最重要的预测因素。结论：贝伐珠单抗再照射对于复发性高级别胶质瘤患者是一种可行且有效的治疗方法。有必要进行随机试验来最终回答贝伐珠单抗是否能为放射治疗再治疗环境带来实质性益处的问题。 (C) 2012 爱思唯尔公司。
Purpose: Reirradiation is a treatment option for recurrent high-grade glioma with proven but limited effectiveness. Therapies directed against vascular endothelial growth factor have been shown to exert certain efficacy in combination with chemotherapy and have been safely tested in combination with radiotherapy in a small cohort of patients. To study the feasibility of reirradiation combined with bevacizumab treatment, the toxicity and treatment outcomes of this approach were analyzed retrospectively.Patients and Methods: After previous treatment with standard radiotherapy (with or without temozolomide) patients with recurrent malignant glioma received bevacizumab (10 mg/kg intravenous) on Day 1 and Day 15 during radiotherapy. Maintenance therapy was selected based on individual considerations, and mainly bevacizumab-containing regimens were chosen. Patients received 36 Gy in 18 fractions.Results: The data of the medical charts of the 30 patients were analyzed retrospectively. All were irradiated in a single institution and received either bevacizumab (n = 20), no additional substance (n = 7), or temozolomide (n = 3). Reirradiation was tolerated well, regardless of the added drug. In 1 patient treated with bevacizumab, a wound dehiscence occurred. Overall survival was significantly better in patients receiving bevacizumab (p = 0.03, log-rank test). In a multivariate proportional hazards Cox model, bevacizumab, Karnovsky performance status, and World Health Organization grade at relapse turned out to be the most important predictors for overall survival.Conclusion: Reirradiation with bevacizumab is a feasible and effective treatment for patients with recurrent high-grade gliomas. A randomized trial is warranted to finally answer the question whether bevacizumab adds substantial benefit to a radiotherapeutic retreatment setting. (C) 2012 Elsevier Inc.