Journal of Neuro-Oncology

, Volume 117, Issue 2, pp 337–345 | Cite as

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

  • Maya Flieger
  • Ute Ganswindt
  • Silke Birgit Schwarz
  • Friedrich-Wilhelm Kreth
  • Jörg-Christian Tonn
  • Christian la Fougère
  • Lorenz Ertl
  • Jennifer Linn
  • Ulrich Herrlinger
  • Claus Belka
  • Maximilian Niyazi
Clinical Study


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.


Bevacizumab Re-irradiation Radiotherapy Glioma Glioblastoma 


Conflict of interest

The authors declare that conflicts of interest do not exist.

Supplementary material

11060_2014_1394_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 40 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maya Flieger
    • 1
  • Ute Ganswindt
    • 1
  • Silke Birgit Schwarz
    • 1
  • Friedrich-Wilhelm Kreth
    • 2
  • Jörg-Christian Tonn
    • 2
  • Christian la Fougère
    • 3
  • Lorenz Ertl
    • 4
  • Jennifer Linn
    • 4
  • Ulrich Herrlinger
    • 5
  • Claus Belka
    • 1
  • Maximilian Niyazi
    • 1
  1. 1.Department of Radiation OncologyUniversity of MunichMunichGermany
  2. 2.Department of NeurosurgeryUniversity of MunichMunichGermany
  3. 3.Department of Nuclear MedicineUniversity of MunichMunichGermany
  4. 4.Department of NeuroradiologyUniversity of MunichMunichGermany
  5. 5.Division of Clinical Neurooncology, Department of NeurologyUniversity of Bonn Medical CenterBonnGermany

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