International Journal of Radiation Oncology*Biology*Physics
Bevacizumab and Radiosurgery for Recurrent Malignant Glioma: Toxicity Results from a Prospective Pilot Study
Section snippets
Purpose/Objective(s)
Most patients with a malignant glioma recur after primary therapy. Bevacizumab (BVZ) has been shown in Phase II trials to improve disease-free survival in patients with recurrent glioma. Retrospective studies of stereotactic radiosurgery (SRS) for recurrent glioma have also suggested improved outcomes.
Materials/Methods
Patients with a recurrent unifocal Grade III or IV malignant glioma who were no longer responsive to chemotherapy were eligible for this institutional review board-approved pilot study. All patients were imaged with MRI and CT for SRS planning. The contrast-enhancing lesion on T1-weighted MRI was expanded 1 mm to yield the planning target volume. Lesions <2 cm and 2 – 2.9 cm in size were prescribed 24 and 18 Gy in a single fraction, respectively. Lesions measuring 3 – 5 cm were prescribed 25 Gy
Results
Fifteen subjects were enrolled between January 2010 and January 2011, completing targeted accrual. Median age and KPS at the time of SRS were 53 years (range, 25 – 66) and 90 (range, 80 – 100), respectively. Fourteen of 15 patients included in the study were previously treated with a BVZ-containing regimen. Median time from primary diagnosis to salvage SRS was 19.6 months. No patient experienced a cerebrovascular accident or thrombotic event. No Grade 4/5 adverse events were seen. One patient
Conclusions
Treatment with stereotactic radiosurgery and BVZ in heavily pre-treated patients with a recurrent malignant glioma appears well tolerated. Further follow-up in a larger patient cohort is needed to test the efficacy of this approach.
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Author Disclosure: K.C. Cuneo: None. A.R. Cabrera: None. J. Sampson: None. K. Allen: None. E. Duffy: None. J.J. Vredenburgh: None. K.B. Peters: None. Z. Chang: None. A. Desjardins: None. J.P. Kirkpatrick: None.