Yi-Lun Chen1, Abel Po-Hao Huang2, Chia-Chun Wang1, Hung-Yi Chen1, Ya-Fang Chen3, Furen Xiao2, Shao-Lun Lu1, Jason Chia-Hsien Cheng1,4, Feng-Ming Hsu5,6. 1. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei, 10002, Taiwan. 2. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 3. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. 4. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan. 5. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei, 10002, Taiwan. hsufengming@ntuh.gov.tw. 6. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan. hsufengming@ntuh.gov.tw.
Abstract
INTRODUCTION: Stereotactic radiosurgery (SRS) is a standard of care for brain metastases (BM) patients, yet large BM are at a greater risk for radionecrosis and local progression (LP). Concomitant bevacizumab and radiotherapy has been shown to improve outcomes in primary and metastatic brain tumors. This retrospective study investigated the efficacy and safety of concurrent bevacizumab and SRS for large BM. METHODS: From 2015 to 2019, patients with a BM diameter ≥ 2 cm who received either combination therapy (n = 49, SRS + BVZ group), or SRS alone (n = 73, SRS group) were enrolled. Bevacizumab was given peri-radiosurgically with a 2-week interval. Radiographic response was assessed using the RECIST version 1.1. Competing risk and logistic regression analysis were performed to evaluate prognostic factors. RESULTS: Radiographic response was achieved in 41 patients (84%) in the SRS + BVZ group and 37 patients (51%) in the SRS group (p = 0.001). In the multivariate regression analysis, concurrent bevacizumab was independently associated with a better radiographic response (p = 0.003). The cumulative incidences of LP and ≥ grade 2 radionecrosis at 12 months between the SRS + BVZ group and SRS group were 2% versus 6.8%, and 14.3% versus 14.6%, respectively. For patients with BM size ≥ 3 cm, the cumulative incidence of LP was significantly lower in the SRS + BVZ group (p = 0.03). No ≥ grade 4 toxicity was observed in either group. CONCLUSIONS: Concurrent bevacizumab and SRS for large BM is highly effective, with a better radiographic response and minimal excessive treatment-related toxicities. Peri-radiosurgical bevacizumab preferentially reduced the risk of LP, especially for BM size ≥ 3 cm.
INTRODUCTION: Stereotactic radiosurgery (SRS) is a standard of care for brain metastases (BM) patients, yet large BM are at a greater risk for radionecrosis and local progression (LP). Concomitant bevacizumab and radiotherapy has been shown to improve outcomes in primary and metastatic brain tumors. This retrospective study investigated the efficacy and safety of concurrent bevacizumab and SRS for large BM. METHODS: From 2015 to 2019, patients with a BM diameter ≥ 2 cm who received either combination therapy (n = 49, SRS + BVZ group), or SRS alone (n = 73, SRS group) were enrolled. Bevacizumab was given peri-radiosurgically with a 2-week interval. Radiographic response was assessed using the RECIST version 1.1. Competing risk and logistic regression analysis were performed to evaluate prognostic factors. RESULTS: Radiographic response was achieved in 41 patients (84%) in the SRS + BVZ group and 37 patients (51%) in the SRS group (p = 0.001). In the multivariate regression analysis, concurrent bevacizumab was independently associated with a better radiographic response (p = 0.003). The cumulative incidences of LP and ≥ grade 2 radionecrosis at 12 months between the SRS + BVZ group and SRS group were 2% versus 6.8%, and 14.3% versus 14.6%, respectively. For patients with BM size ≥ 3 cm, the cumulative incidence of LP was significantly lower in the SRS + BVZ group (p = 0.03). No ≥ grade 4 toxicity was observed in either group. CONCLUSIONS: Concurrent bevacizumab and SRS for large BM is highly effective, with a better radiographic response and minimal excessive treatment-related toxicities. Peri-radiosurgical bevacizumab preferentially reduced the risk of LP, especially for BM size ≥ 3 cm.
Authors: Eric J Lehrer; Jennifer L Peterson; Nicholas G Zaorsky; Paul D Brown; Arjun Sahgal; Veronica L Chiang; Samuel T Chao; Jason P Sheehan; Daniel M Trifiletti Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-02 Impact factor: 7.038
Authors: Paul D Brown; Karla V Ballman; Jane H Cerhan; S Keith Anderson; Xiomara W Carrero; Anthony C Whitton; Jeffrey Greenspoon; Ian F Parney; Nadia N I Laack; Jonathan B Ashman; Jean-Paul Bahary; Costas G Hadjipanayis; James J Urbanic; Fred G Barker; Elana Farace; Deepak Khuntia; Caterina Giannini; Jan C Buckner; Evanthia Galanis; David Roberge Journal: Lancet Oncol Date: 2017-07-04 Impact factor: 41.316
Authors: Paul D Brown; Kurt Jaeckle; Karla V Ballman; Elana Farace; Jane H Cerhan; S Keith Anderson; Xiomara W Carrero; Fred G Barker; Richard Deming; Stuart H Burri; Cynthia Ménard; Caroline Chung; Volker W Stieber; Bruce E Pollock; Evanthia Galanis; Jan C Buckner; Anthony L Asher Journal: JAMA Date: 2016-07-26 Impact factor: 56.272
Authors: Zachary A Kohutek; Yoshiya Yamada; Timothy A Chan; Cameron W Brennan; Viviane Tabar; Philip H Gutin; T Jonathan Yang; Marc K Rosenblum; Åse Ballangrud; Robert J Young; Zhigang Zhang; Kathryn Beal Journal: J Neurooncol Date: 2015-08-26 Impact factor: 4.130
Authors: Eric L Chang; Jeffrey S Wefel; Kenneth R Hess; Pamela K Allen; Frederick F Lang; David G Kornguth; Rebecca B Arbuckle; J Michael Swint; Almon S Shiu; Moshe H Maor; Christina A Meyers Journal: Lancet Oncol Date: 2009-10-02 Impact factor: 41.316