Takayuki Yasuda1, Yoshihiro Muragaki2, Masayuki Nitta3, Kazunari Miyamoto4, Yuko Oura4, Takuo Henmi5, Sanshiro Noguchi5, Hideaki Oda5, Taiichi Saito1, Takashi Maruyama3, Shoko Atsuchi6, Naohisa Miura6, Takakazu Kawamata1. 1. Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. 2. Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Faculty of Advanced Techno-Surgery, Institute of Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. Electronic address: ymuragaki@twmu.ac.jp. 3. Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Faculty of Advanced Techno-Surgery, Institute of Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. 4. Department of Radiation therapy, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan. 5. Department of Pathology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. 6. Department of Neurosurgery, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan.
Abstract
OBJECTIVE: This study aimed to evaluate the efficacy of stereotactic radiotherapy combined with bevacizumab (SRT-Bv) compared with Bv treatment for recurrent high-grade gliomas (HGGs). METHODS: Data for patients with recurrent HGGs who received SRT and Bv (n = 29) or Bv (n = 29) between June 2014 and September 2016 were retrospectively analyzed. All patients received conventional radiotherapy (total, 60 Gy) before this study. SRT was administered at a median dose of 42 Gy in 3-7 fractions. The recurrence pattern was classified into 3 groups: in-field, marginal, and out-field. RESULTS: The median overall survival in the SRT-Bv group was significantly longer than that in the Bv group (10.4 vs. 5.6 months; P = 0.02). In patients with isocitrate dehydrogenase wild-type tumors, the SRT-Bv treatment significantly prolonged survival more than the Bv treatment (10.9 vs. 8.2 months; P = 0.01). The World Health Organization grade and presence or absence of SRT were significant prognostic factors in the univariate analysis. Besides brain edema in 2 cases and asymptomatic subdural hematoma in 1 case, no other severe adverse effect due to SRT-Bv treatment was recorded. The pattern of recurrence was as follows: in-field, 2 cases (7%); marginal, 8 cases (28%); out-field, 11 cases (38%); no recurrence on radiologic findings, 6 cases (21%); and uncertain, 2 cases (7%). CONCLUSIONS: SRT-Bv treatment significantly prolonged survival duration more than Bv treatment and provides good local control in patients with recurrent HGGs, especially those with isocitrate dehydrogenase wild-type tumors.
OBJECTIVE: This study aimed to evaluate the efficacy of stereotactic radiotherapy combined with bevacizumab (SRT-Bv) compared with Bv treatment for recurrent high-grade gliomas (HGGs). METHODS: Data for patients with recurrent HGGs who received SRT and Bv (n = 29) or Bv (n = 29) between June 2014 and September 2016 were retrospectively analyzed. All patients received conventional radiotherapy (total, 60 Gy) before this study. SRT was administered at a median dose of 42 Gy in 3-7 fractions. The recurrence pattern was classified into 3 groups: in-field, marginal, and out-field. RESULTS: The median overall survival in the SRT-Bv group was significantly longer than that in the Bv group (10.4 vs. 5.6 months; P = 0.02). In patients with isocitrate dehydrogenase wild-type tumors, the SRT-Bv treatment significantly prolonged survival more than the Bv treatment (10.9 vs. 8.2 months; P = 0.01). The World Health Organization grade and presence or absence of SRT were significant prognostic factors in the univariate analysis. Besides brain edema in 2 cases and asymptomatic subdural hematoma in 1 case, no other severe adverse effect due to SRT-Bv treatment was recorded. The pattern of recurrence was as follows: in-field, 2 cases (7%); marginal, 8 cases (28%); out-field, 11 cases (38%); no recurrence on radiologic findings, 6 cases (21%); and uncertain, 2 cases (7%). CONCLUSIONS: SRT-Bv treatment significantly prolonged survival duration more than Bv treatment and provides good local control in patients with recurrent HGGs, especially those with isocitrate dehydrogenase wild-type tumors.
Authors: Daniel P Kulinich; John P Sheppard; Thien Nguyen; Aditya M Kondajji; Ansley Unterberger; Courtney Duong; Adam Enomoto; Kunal Patel; Isaac Yang Journal: Acta Neurochir (Wien) Date: 2021-04-02 Impact factor: 2.216