Department of Radiation Oncology, New York University Langone Medical Center, New York, NY 10016, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):77-82. doi: 10.1016/j.ijrobp.2010.10.038. Epub 2010 Dec 14.
Local recurrence is the dominant pattern of relapse in high-grade glioma (HGG) after conventional therapy. The recent use of antiangiogenic therapy has shown impressive radiologic and clinical responses in adult HGG. The preclinical data suggesting increased invasiveness after angiogenic blockade have necessitated a detailed analysis of the pattern of recurrence after therapy.
A total of 162 consecutive patients with HGG, either newly diagnosed (n = 58) or with recurrent disease (n = 104) underwent therapy with bevacizumab at 10 mg/kg every 2 weeks and conventional chemotherapy with or without involved field radiotherapy until disease progression. The pattern of recurrence and interval to progression were the primary aims of the present study. Diffuse invasive recurrence (DIR) was defined as the involvement of multiple lobes with or without crossing the midline.
At a median follow-up of 7 months (range, 1-37), 105 patients had recurrence, and 79 patients ultimately developed DIR. The interval to progression was similar in the DIR and local recurrence groups (6.5 and 6.3 months, p = .296). The hazard risk of DIR increased exponentially with time and was similar in those with newly diagnosed and recurrent HGG (R(2) = 0.957). The duration of bevacizumab therapy increased the interval to recurrence (p < .0001) and improved overall survival (p < .0001). However, the pattern of relapse did not affect overall survival (p = .253).
Along with an increase in median progression-free survival, bevacizumab therapy increased the risk of DIR in HGG patients. The risk of increased invasion with prolonged angiogenic blockade should be addressed in future clinical trials.
在常规治疗后，高级别神经胶质瘤（HGG）的局部复发是主要的复发模式。最近抗血管生成治疗在成人 HGG 中显示出令人印象深刻的影像学和临床反应。血管生成阻断后侵袭性增加的临床前数据需要对治疗后复发模式进行详细分析。
共 162 例连续的 HGG 患者，无论是新诊断（n = 58）还是复发性疾病（n = 104），均接受贝伐单抗 10mg/kg 每 2 周治疗，联合或不联合受累野放疗的常规化疗，直至疾病进展。本研究的主要目的是复发模式和进展时间间隔。弥漫性浸润性复发（DIR）定义为多个脑叶受累，无论是否中线穿过。
中位随访 7 个月（范围，1-37），105 例患者复发，79 例患者最终出现 DIR。DIR 和局部复发组的进展时间间隔相似（6.5 和 6.3 个月，p =.296）。DIR 的危险风险随时间呈指数增长，在新诊断和复发性 HGG 患者中相似（R(2) = 0.957）。贝伐单抗治疗的持续时间增加了复发时间间隔（p <.0001）并改善了总生存（p <.0001）。然而，复发模式并未影响总生存（p =.253）。
随着中位无进展生存期的延长，贝伐单抗治疗增加了 HGG 患者 DIR 的风险。在未来的临床试验中，应解决长期血管生成阻断增加侵袭的风险。
