Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option
Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option
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DOI：
10.1007/s11060-014-1394-5
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发表时间：
2014-04-01
影响因子：
3.9
通讯作者：
Niyazi, Maximilian
中科院分区：
文献类型：
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作者：
Flieger, Maya;Ganswindt, Ute;Niyazi, Maximilian
对于复发性高级别胶质瘤 (HGG) 患者来说，再照射已被证明是一种有意义的选择。此外，贝伐珠单抗与化疗/单一疗法联合发挥一定的活性，并且在之前的几项研究中与放疗联合进行了安全测试。据我们所知，这是迄今为止接受再照射和贝伐珠单抗治疗的最大的患者群体。接受标准放疗（联合或不联合 TMZ）后，复发性 HGG 患者在再次放疗期间接受贝伐珠单抗（第 1 天和第 15 天静脉注射 10 mg/kg）。再治疗期间的中位规定辐射剂量为 36 Gy，按常规分割。对 71 名再照射患者的数据集进行了回顾性分析。患者要么接受贝伐单抗治疗（N = 57），要么不接受贝伐单抗治疗（N = 14；其他药物治疗（N = 4）和单独放射治疗（N = 10））。在接受贝伐珠单抗治疗的患者中，复发后生存期 (PRS)（中位 8.6 个月与 5.7 个月；p = 0.003，对数秩检验）和复发后无进展生存期（PR-PFS，5.6 个月对 2.5 个月；p = 0.005，对数秩检验；贝伐珠单抗组的 PFS-6 为 42.1%）均显着增加，这一点通过多变量分析。 KPS、再次手术、MGMT 甲基化状态、性别、WHO 分级、肿瘤体积和年龄都不是 PR-PFS 和 PRS 的显着预测因素（单变量分析）。贝伐珠单抗再次照射仍然是一种可行且高效的治疗方案。有必要研究进一步的挽救策略以及序贯治疗选择与观察的时机。
Re-irradiation has been shown to be a meaningful option for recurrent high-grade glioma (HGG) patients. Furthermore, bevacizumab exerts certain activity in combination with chemotherapy/as monotherapy and was safely tested in combination with radiotherapy in several previous studies. To our knowledge, this is the largest cohort of patients treated with both re-irradiation and bevacizumab to date. After receiving standard radiotherapy (with or without TMZ) patients with recurrent HGG were treated with bevacizumab (10 mg/kg intravenously at d1 and d15) during re-irradiation. Median prescribed radiation dose during re-treatment was 36 Gy, conventionally fractionated. Datasets of 71 re-irradiated patients were retrospectively analyzed. Patients either received bevacizumab (N = 57) or not (N = 14; other substances (N = 4) and sole radiation (N = 10)). In patients receiving bevacizumab, both post-recurrence survival (PRS) (median 8.6 vs. 5.7 months; p = 0.003, log-rank test) and post-recurrence progression-free survival (PR-PFS, 5.6 vs. 2.5 months; p = 0.005, log-rank test; PFS-6 42.1 % for the bevacizumab group) were significantly increased which was confirmed by multivariate analysis. KPS, re-surgery, MGMT methylation status, sex, WHO grade, tumor volume and age were no significant predictors for neither PR-PFS nor PRS (univariate analysis). Re-irradiation with bevacizumab remains a feasible and highly effective treatment schedule. Studies on further salvage strategies and timing of sequential treatment options versus observation are warranted.