Skip to main content

Advertisement

Log in

The role of salvage reirradiation for malignant gliomas that progress on bevacizumab

  • Clinical Study - Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Bevacizumab and irinotecan are effective against recurrent malignant gliomas. However, at subsequent progression, patients rarely respond to a second bevacizumab-containing chemotherapeutic regimen. Salvage re-irradiation with bevacizumab for recurrent but bevacizumab naive malignant gliomas showed encouraging results. We performed a retrospective review of the medical records of 23 patients treated with either fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS) after progression on an initial bevacizumab regimen. Patients were treated after re-irradiation with bevacizumab but combined with a different chemotherapy. We then compared them to another 23 patients who progressed on an initial bevacizumab + chemotherapy regimen. These patients did not receive re-irradiation but bevacizumab was continued combined with a different chemotherapy. Patients treated with FSRT/SRS/bevacizumab had a longer median progression-free period (2.6 vs. 1. 7 months, P = 0.009), longer median post FSRT/SRS treatment survival (7.2 vs. 3.3 months, P = 0.03) and higher radiographic response rate (22 vs. 0%, P = 0.049). FSRT or SRS followed by bevacizumab + chemotherapy may have a role for patients who progress on bevacizumab.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Norden AD, Young GS, Setayesh K, Muzikansky A, Klufas R, Ross GL, Ciampa AS, Ebbeling LG, Levy B, Drappatz J, Kesari S, Wen PY (2008) Bevacizumab for recurrent malignant gliomas. Efficacy, toxicity, and patterns of recurrence. Neurology 70:779–787

    Article  CAS  PubMed  Google Scholar 

  2. Quant E, Norden A, Drappatz J, Muzikansky A, Doherty L, LaFrankie D, Ciampa A, Kesari K, Wen PY (2009) Role of a second chemotherapy in recurrent malignant glioma patients who progress on bevacizumab. Neuro Oncol 11(5):550–555. doi:10.1215/15228517-2009-006

    Article  CAS  PubMed  Google Scholar 

  3. Combs S, Thilmann C, Edler L, Debus J, Schulz-Ertner D (2005) Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 23:9963–9969

    Google Scholar 

  4. Patel M, Siddiqui F, Jian-Yue J, Mikkelsen T, Rosenblum M, Movsas B, Ryu S (2009) Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival. J Neurooncol 92:185–191

    Article  PubMed  Google Scholar 

  5. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    CAS  PubMed  Google Scholar 

  6. Jin JY, Yin FF, Ryu S, Ajlouni M, Kim JH (2005) Dosimetric study using different leaf-width MLCs for treatment planning of dynamic conformal arcs and intensity-modulated radiosurgery. Med Phys 32:405–411. doi:10.1118/1.1842911

    Article  PubMed  Google Scholar 

  7. Jin JY, Ryu S, Faber K, Mikkelsen T, Chen Q, Li S, Movsas B (2006) 2D/3D image fusion for accurate target localization and evaluation of a mask based stereotactic system in fractionated stereotactic radiotherapy of cranial lesions. Med Phys 33:4557–4566. doi:10.1118/1.2392605

    Article  PubMed  Google Scholar 

  8. Gutin PH, Iwamoto FM, Beal K, Mohile NA, Karimi S, Hou BL, Lymberis S, Yamada Y, Chang J, Abrey L (2008) Safety and efficacy of bevacizumab with hypofractionated stereotactic irradiation for recurrent malignant gliomas. Int J Radiat Oncol Biol Phys 75(1):156–163

    Google Scholar 

  9. Zuniga RM, Torcuator R, Jain R, Anderson J, Doyle T, Ellika S, Schultz L, Mikkelsen T (2009) Efficacy, safety and patterns of response and recurrence in patients with recurrent high-grade gliomas treated with bevacizumab plus irinotecan. J Neurooncol 91:329–336

    Article  CAS  PubMed  Google Scholar 

  10. Vredenburgh J, Desjardins A, Herndon J II, Marcello J, Reardon D, Quinn J, Rich J, Sathornsumetee S, Gururangan S, Sampson J, Wagner M, Bailey L, Bigner D, Friedman A, Friedman H (2007) Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 25:4722–4729

    Article  CAS  PubMed  Google Scholar 

  11. Kreisl T, Kim L, Moore K, Duic P, Royce C, Stroud I, Garren N, Mackey M, Butman J, Camphausen K, Park J, Albert P, Fine H (2009) Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol 27:740–745

    Article  CAS  PubMed  Google Scholar 

  12. Lai A, Filka E, McGibbon B, Nghiemphu P, Graham C, Yong W, Paul MP, Liau L, Bergsneider M, Pope W, Selch M, Cloughesy T (2008) PHASE II pilot study of bevacizumab in combination temozolomide and regional radiation therapy for up-front treatment of patients with newly diagnosed glioblastoma multiforme: interim analysis of safety and tolerability. Int J Radiat Oncol Biol Phys 71:1372–1380

    CAS  PubMed  Google Scholar 

  13. Narayana A, Golfinos J, Fisache I, Raza S (2008) Feasibility of using bevacizumab with radiation therapy and temozolomide in newly diagnosed high-grade glioma. Int J Radiat Oncol Biol Phys 72:383–389

    CAS  PubMed  Google Scholar 

  14. Milas L, Ito H, Hunter N, Jones S, Peters LJ (1986) Retardation of tumor growth in mice caused by radiation-induced injury of tumor bed stroma: dependency on tumor type. Cancer Res 46:723–727

    CAS  PubMed  Google Scholar 

  15. Ahn GO, Brown JM (2008) Matrix metalloproteinase-9 is required for tumor vasculogenesis but not for angiogenesis: role of bone marrow-derived myelomonocytic cells. Cancer Cell 13:193–205

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roy G. Torcuator.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torcuator, R.G., Thind, R., Patel, M. et al. The role of salvage reirradiation for malignant gliomas that progress on bevacizumab. J Neurooncol 97, 401–407 (2010). https://doi.org/10.1007/s11060-009-0034-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-009-0034-y

Keywords

Navigation