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Hypofractionated stereotactic radiotherapy in combination with bevacizumab or fotemustine for patients with progressive malignant gliomas

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Abstract

To evaluate the efficacy of hypofractionated stereotactic radiotherapy performed as reirradiation in combination with fotemustine or bevacizumab as salvage treatment in patients with recurrent malignant glioma. Between May 2006 and December 2013, 54 patients with recurrent malignant glioma received hypofractionated stereotactic radiotherapy (HSRT, 25 Gy in 5-Gy fractions) plus either fotemustine or bevacizumab at University of Rome Sapienza, Sant’Andrea Hospital. All patients had Karnofsky performance score (KPS) ≥ 60 and were previously treated with standard chemoradiotherapy. Forty-two patients had a GBM and 12 patients had an anaplastic astrocytoma (AA). The median overall survival (OS) time and 12-month OS rates after HSRT was 11 months and 30 % for patients treated with HSRT plus bevacizumab and 8.3 months and 5 % for those treated with HSRT plus fotemustine (p = 0.01). Median PFS times were 4 and 6 months for patients treated with HSRT plus fotemustine or bevacizumab, respectively (p = 0.01). KPS > 70 (p = 0.04), AA histology, and the treatment with bevacizumab were independent favourable prognostic factors for OS. In general, both treatments were well tolerated with relatively low treatment-related toxicity. HSRT combined with bevacizumab or fotemustine may represent a feasible treatment option for patients with progressive malignant gliomas, although most of the tumors recur in a few months. Efficacy of bevacizumab or alkylating agents in combination with different radiation schedules needs to be evaluated in prospective studies.

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Acknowledgments

We would like to thank Professor Alessandro Bozzao and Dr. Andrea Romano, neuroradiologists at Sant’Andrea Hospital, for reviewing all MRI scans. We also would like to thank the nursing staff and radiographers of the Radiation Oncology and Physics Units at Sant’Andrea Hospital for their valuable assistance during the study. Finally, we wish to thank all of the patients who participated in this study.

Conflict of interest

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Unit of Radiation Oncology, Sant’Andrea Hospital, University Sapienza, Rome, Italy

    Giuseppe Minniti, Linda Agolli, Teresa Falco, Claudia Scaringi, Mattia Falchetto Osti & Riccardo Maurizi Enrici

  2. IRCCS Neuromed, Pozzilli, Isernia, Italy

    Giuseppe Minniti, Gaetano Lanzetta & Vincenzo Esposito

  3. Medical Oncology Unit, Sant’Andrea Hospital, University Sapienza, Rome, Italy

    Paola Caporello

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  1. Giuseppe Minniti
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  2. Linda Agolli
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  3. Teresa Falco
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Correspondence to Giuseppe Minniti.

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Minniti, G., Agolli, L., Falco, T. et al. Hypofractionated stereotactic radiotherapy in combination with bevacizumab or fotemustine for patients with progressive malignant gliomas. J Neurooncol 122, 559–566 (2015). https://doi.org/10.1007/s11060-015-1745-x

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