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Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option

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Abstract

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.

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Conflict of interest

The authors declare that conflicts of interest do not exist.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Maya Flieger, Ute Ganswindt, Silke Birgit Schwarz, Claus Belka & Maximilian Niyazi

  2. Department of Neurosurgery, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Friedrich-Wilhelm Kreth & Jörg-Christian Tonn

  3. Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Christian la Fougère

  4. Department of Neuroradiology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Lorenz Ertl & Jennifer Linn

  5. Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53127, Bonn, Germany

    Ulrich Herrlinger

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  1. Maya Flieger
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  2. Ute Ganswindt
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Correspondence to Maximilian Niyazi.

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All authors except UH are members of the CCC Neuro-Oncology, University of Munich.

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Flieger, M., Ganswindt, U., Schwarz, S.B. et al. Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option. J Neurooncol 117, 337–345 (2014). https://doi.org/10.1007/s11060-014-1394-5

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  • DOI: https://doi.org/10.1007/s11060-014-1394-5

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