Neuro-Oncology: Salvage gamma knife stereotactic radiosurgery followed by bevacizumab for recurrent glioblastoma mul

Wednesday, November 9, 2011

Salvage gamma knife stereotactic radiosurgery followed by bevacizumab for recurrent glioblastoma mul

Abstract

We evaluated the efficacy and safety of gamma knife stereotactic radiosurgery (GKSR) followed by bevacizumab combined with chemotherapy in 11 patients with recurrent glioblastoma multiforme who experienced tumor progression despite aggressive initial multi-modality treatment. Our experience included eight male and three female patients. The median patient age at GKSR was 62 years (range 46–72 years). At the time of GKSR, seven patients had a first recurrence and four had two or more recurrences. The median interval from the initial diagnosis until GKSR was 17 months (range 5–34.5 months). The median tumor volume was 13.6 cm³ (range 1.2–45.1 cm³) and the median margin dose of GKSR was 16 Gy (range 13–18 Gy). Following GKSR, bevacizumab was administrated with irinotecan in nine patients and with temozolomide in one patient. One patient was treated with bevacizumab monotherapy. The treatment outcomes were compared to 44 case-matched controls who underwent GKSR without additional bevacizumab. At a median of 13.7 months (range 4.6–28.3 months) after radiosurgery, tumor progression was evident in seven patients. The median progression-free survival (PFS) was 15 months (95% confidential interval (CI), 6.5–23.3 months). Six-month and 1-year PFS rates were 73 and 55%, respectively. The median overall survival (OS) from GKSR was 18 months (95% CI, 10.1–25.7 months) and 1-year OS rate was 73%. One patient (9%) experienced grade III toxicity and one patient (9%) had major adverse radiation effects. Compared with patients who did not receive bevacizumab, the patients who received bevacizumab had significantly prolonged PFS (15 months vs. 7 months, P = 0.035) and OS (18 months vs. 12 months, P = 0.005), and were less likely to develop an adverse radiation effect (9 vs. 46%, P = 0.037). The combination of salvage GKSR followed by bevacizumab added potential benefit and little additional risk in a small group of patients with progressive glioblastoma. Further experience is needed to define the efficacy and long-term toxicity with this strategy.

Content Type Journal Article
Category Clinical Study - Patient Study
Pages 1-11
DOI 10.1007/s11060-011-0744-9
Authors
- Kyung-Jae Park, Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea
- Hideyuki Kano, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Aditya Iyer, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Xiaomin Liu, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Ajay Niranjan, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- John C. Flickinger, Departments of Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
- Frank S. Lieberman, Departments of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- L. Dade Lunsford, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Douglas Kondziolka, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA