Abstract
BACKGROUND
High-grade gliomas (HGGs) comprise the most common primary adult brain cancers and universally recur. Glioblastoma (GBM) compromise 60% of HGGs with an extremely poor prognosis and are considered incurable despite many treatment advancements. Combination re-radiation therapy (re-RT) and bevacizumab (BVZ) therapy for recurrent HGG is commonly used, however, there is a paucity of literature with respect to its efficacy.
OBJECTIVE
This study aimed to compare treatment outcomes of patients who received reRT alone versus a combination of reRT and BVZ (reRT ± BVZ ) to establish clear guidelines for the optimal management of recurrent GBM.
METHODS
We identified patients with recurrent GBM treated via reRT ± BVZ. Cohorts were stratified by BVZ treatment status and re-irradiation modality. Primary outcomes of interest included radiation necrosis (RN), progression-free survival (PFS), and overall survival (OS). These parameters were then compared between the reRT + BVZ and the reRT alone cohorts.
RESULTS
A total of 337 patients were included. Mean age at primary resection was 51 years old (range: 5-82). Of those, 223 (66.2%) were male and 114 (33.8%) were female. All patients were initially treated with surgical resection. Mean follow up for the entire cohort was 19.1 months (± 1.14 months). The re-RT + BVZ cohort had a longer median survival at 14 months with 6-, 12-, and 24- month survivals of 84%, 60%, and 19.4%, respectively compared to their re-RT alone counterparts. Our study suggests that the combination of reRT+BVZ is effective in improving overall survival and lowering radiation necrosis rates, compared to reRT alone.
CONCLUSIONS
Combination reRT+BVZ may improve OS and reduce rates of RN in recurrent GBM, but further controlled studies are warranted to validate these effects. Future studies should investigate optimal protocols for reRT+BVZ treatment, and for evaluating subsequent radiologic progression in patients with recurrent GBM.