Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
J Neurooncol. 2020 Jun;148(2):353-361. doi: 10.1007/s11060-020-03526-4. Epub 2020 May 22.
Outcomes for patients with recurrent high-grade glioma (HGG) progressing on bevacizumab (BEV) are dismal. Fractionated stereotactic radiosurgery (FSRS) has been shown to be feasible and safe when delivered in this setting, but prospective evidence is lacking. This single-institution randomized trial compared FSRS plus BEV-based chemotherapy versus BEV-based chemotherapy alone for BEV-resistant recurrent malignant glioma.
HGG patients on BEV with tumor progression after 2 previous treatments were randomized to 1) FSRS plus BEV-based chemotherapy or 2) BEV-based chemotherapy with irinotecan, etoposide, temozolomide, or carboplatin. FSRS was delivered as 32 Gy (8 Gy × 4 fractions within 2 weeks) to the gross target volume and 24 Gy (6 Gy × 4 fractions) to the clinical target volume (fluid-attenuated inversion recovery abnormality). The primary endpoints were local control (LC) at 2 months and progression-free survival (PFS).
Of the 35 patients enrolled, 29 had glioblastoma (WHO IV) and 6 had anaplastic glioma (WHO III). The median number of prior recurrences was 3. Patients treated with FSRS had significantly improved PFS (5.1 vs 1.8 months, P < .001) and improved LC at 2 months (82% [14/17] vs 27% [4/15], P = .002). The overall median survival was 6.6 months (7.2 months with FSRS vs 4.8 months with chemotherapy alone, P = .11).
FSRS combined with BEV-based chemotherapy in recurrent HGG patients progressing on BEV is feasible and improves LC and PFS when compared to treatment with BEV-based chemotherapy alone.
贝伐单抗（bevacizumab，BEV）治疗后复发的高级别胶质瘤（high-grade glioma，HGG）患者的预后较差。在这种情况下，分次立体定向放射外科手术（fractionated stereotactic radiosurgery，FSRS）已被证明是可行且安全的，但缺乏前瞻性证据。本单中心随机试验比较了 FSRS 联合 BEV 为基础的化疗与单独 BEV 为基础的化疗治疗 BEV 耐药性复发性恶性胶质瘤的效果。
接受 BEV 治疗后肿瘤进展的 HGG 患者，在前 2 次治疗后随机分为 1）FSRS 联合 BEV 为基础的化疗组或 2）BEV 为基础的化疗联合伊立替康、依托泊苷、替莫唑胺或卡铂组。FSRS 采用 32 Gy（2 周内 8 Gy×4 次分割）照射大体肿瘤靶区，24 Gy（6 Gy×4 次分割）照射临床靶区（液体衰减反转恢复异常）。主要终点为 2 个月时的局部控制（LC）和无进展生存期（PFS）。
35 例患者中，29 例为胶质母细胞瘤（WHO IV 级），6 例为间变星形细胞瘤（WHO III 级）。中位复发次数为 3 次。接受 FSRS 治疗的患者 PFS 显著改善（5.1 个月比 1.8 个月，P<.001），2 个月时 LC 也显著改善（82%[14/17]比 27%[4/15]，P=.002）。中位总生存期为 6.6 个月（FSRS 组为 7.2 个月，单独化疗组为 4.8 个月，P=.11）。
在接受 BEV 治疗后复发的 HGG 患者中，FSRS 联合 BEV 为基础的化疗是可行的，与单独接受 BEV 为基础的化疗相比，可提高 LC 和 PFS。
