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Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial.

Publication ,  Journal Article
Cabrera, AR; Cuneo, KC; Desjardins, A; Sampson, JH; McSherry, F; Herndon, JE; Peters, KB; Allen, K; Hoang, JK; Chang, Z; Craciunescu, O ...
Published in: Int J Radiat Oncol Biol Phys
August 1, 2013

PURPOSE: Virtually all patients with malignant glioma (MG) eventually recur. This study evaluates the safety of concurrent stereotactic radiosurgery (SRS) and bevacizumab (BVZ), an antiangiogenic agent, in treatment of recurrent MG. METHODS AND MATERIALS: Fifteen patients with recurrent MG, treated at initial diagnosis with surgery and adjuvant radiation therapy/temozolomide and then at least 1 salvage chemotherapy regimen, were enrolled in this prospective trial. Lesions <3 cm in diameter were treated in a single fraction, whereas those 3 to 5 cm in diameter received 5 5-Gy fractions. BVZ was administered immediately before SRS and 2 weeks later. Neurocognitive testing (Mini-Mental Status Exam, Trail Making Test A/B), Functional Assessment of Cancer Therapy-Brain (FACT-Br) quality-of-life assessment, physical exam, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were performed immediately before SRS and 1 week and 2 months following completion of SRS. The primary endpoint was central nervous system (CNS) toxicity. Secondary endpoints included survival, quality of life, microvascular properties as measured by DCE-MRI, steroid usage, and performance status. RESULTS: One grade 3 (severe headache) and 2 grade 2 CNS toxicities were observed. No patients experienced grade 4 to 5 toxicity or intracranial hemorrhage. Neurocognition, quality of life, and Karnofsky performance status did not change significantly with treatment. DCE-MRI results suggest a significant decline in tumor perfusion and permeability 1 week after SRS and further decline by 2 months. CONCLUSIONS: Treatment of recurrent MG with concurrent SRS and BVZ was not associated with excessive toxicity in this prospective trial. A randomized trial of concurrent SRS/BVZ versus conventional salvage therapy is needed to establish the efficacy of this approach.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

August 1, 2013

Volume

86

Issue

5

Start / End Page

873 / 879

Location

United States

Related Subject Headings

  • Tumor Burden
  • Radiotherapy Dosage
  • Radiosurgery
  • Quality of Life
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
 

Citation

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Cabrera, A. R., Cuneo, K. C., Desjardins, A., Sampson, J. H., McSherry, F., Herndon, J. E., … Kirkpatrick, J. P. (2013). Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial. Int J Radiat Oncol Biol Phys, 86(5), 873–879. https://doi.org/10.1016/j.ijrobp.2013.04.029
Cabrera, Alvin R., Kyle C. Cuneo, Annick Desjardins, John H. Sampson, Frances McSherry, James E. Herndon, Katherine B. Peters, et al. “Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial.Int J Radiat Oncol Biol Phys 86, no. 5 (August 1, 2013): 873–79. https://doi.org/10.1016/j.ijrobp.2013.04.029.
Cabrera AR, Cuneo KC, Desjardins A, Sampson JH, McSherry F, Herndon JE, et al. Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial. Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):873–9.
Cabrera, Alvin R., et al. “Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial.Int J Radiat Oncol Biol Phys, vol. 86, no. 5, Aug. 2013, pp. 873–79. Pubmed, doi:10.1016/j.ijrobp.2013.04.029.
Cabrera AR, Cuneo KC, Desjardins A, Sampson JH, McSherry F, Herndon JE, Peters KB, Allen K, Hoang JK, Chang Z, Craciunescu O, Vredenburgh JJ, Friedman HS, Kirkpatrick JP. Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial. Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):873–879.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

August 1, 2013

Volume

86

Issue

5

Start / End Page

873 / 879

Location

United States

Related Subject Headings

  • Tumor Burden
  • Radiotherapy Dosage
  • Radiosurgery
  • Quality of Life
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging