Magnuson William, Ian Robins H, Mohindra Pranshu, Howard Steven
Department of Radiation Oncology, University of Wisconsin, Madison, WI, USA.
J Neurooncol. 2014 Mar;117(1):133-9. doi: 10.1007/s11060-014-1363-z. Epub 2014 Jan 28.
Outcomes after bevacizumab failure for recurrent glioblastoma (GBM) are poor. Our analysis of 16 phase II trials (n = 995) revealed a median overall survival (OS) of 3.8 months (±1.0 month SD) after bevacizumab failure with no discernible activity of salvage chemotherapy. Thus, the optimal treatment for disease progression after bevacizumab has yet to be elucidated. This study evaluated the efficacy of reirradiation for patients with GBM after progression on bevacizumab. An IRB approved retrospective (2/2008-5/2013) analysis was performed of 23 patients with recurrent GBM (after standard radiotherapy/temozolomide) treated with bevacizumab (10 mg/kg) every 2 weeks until progression (median age 53 years; median KPS 80; median progression free survival on bevacizumab 3.7 months). Within 7-14 days of progression on bevacizumab, patients initiated reirradiation to a dose of 54 Gy in 27 fractions using pulsed-reduced dose rate (PRDR) radiotherapy. The median planning target volume was 424 cm(3). At the start of reirradiation, bevacizumab (10 mg/kg) was given every 4 weeks for two additional cycles. The median OS and 6 month OS after bevacizumab failure was 6.9 months and 65 %, respectively. Reirradiation was well tolerated with no symptomatic grade 3-4 toxicities. Favorable outcomes of reirradiation after bevacizumab failure in patients with recurrent GBM suggest its role as a treatment option for large volume recurrences not amenable to stereotactic radiosurgery. As PRDR is easily accomplished from a technological standpoint, we are in the process of expanding this approach to a multi-institutional cooperative group trial.
贝伐单抗治疗复发性胶质母细胞瘤（GBM）失败后的预后较差。我们对16项II期试验（n = 995）的分析显示，贝伐单抗治疗失败后的中位总生存期（OS）为3.8个月（标准差±1.0个月），挽救性化疗无明显活性。因此，贝伐单抗治疗后疾病进展的最佳治疗方法尚未阐明。本研究评估了贝伐单抗治疗进展后GBM患者再次放疗的疗效。对23例复发性GBM患者（标准放疗/替莫唑胺治疗后）进行了一项经机构审查委员会批准的回顾性分析（2008年2月 - 2013年5月），这些患者每2周接受一次贝伐单抗（10 mg/kg）治疗直至疾病进展（中位年龄53岁；中位KPS 80；贝伐单抗治疗的中位无进展生存期3.7个月）。在贝伐单抗治疗进展后的7 - 14天内，患者开始采用脉冲低剂量率（PRDR）放疗，分27次给予54 Gy的再次放疗剂量。中位计划靶体积为424 cm³。再次放疗开始时，每4周给予贝伐单抗（10 mg/kg），额外进行两个周期。贝伐单抗治疗失败后的中位OS和6个月OS分别为6.9个月和65%。再次放疗耐受性良好，无3 - 4级症状性毒性反应。复发性GBM患者贝伐单抗治疗失败后再次放疗的良好结果表明，其可作为不适用于立体定向放射外科治疗的大体积复发的一种治疗选择。由于从技术角度来看PRDR易于实现，我们正在将这种方法扩展至多机构合作组试验。
