Concurrent bevacizumab and temozolomide alter the patterns of failure in radiation treatment of glioblastoma multiforme

Radiation Oncology

Aaron C Spalding³  Todd W Vitaz¹  Robert Kadner²  Lisa BE Shields¹ 

[1] The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA;DXP Imaging, Louisville, KY, USA;Kosair Children’s Hospital, Louisville, KY, USA

关键词: Recurrence;    Temozolomide;    Bevacizumab;    Radiation therapy;    Glioblastoma multiforme;   

Others  :  1154091
DOI  :  10.1186/1748-717X-8-101

 received in 2012-12-04, accepted in 2013-04-11,  发布年份 2013

【 摘 要 】

Background

We investigated the pattern of failure in glioblastoma multiforma (GBM) patients treated with concurrent radiation, bevacizumab (BEV), and temozolomide (TMZ). Previous studies demonstrated a predominantly in-field pattern of failure for GBM patients not treated with concurrent BEV.

Methods

We reviewed the treatment of 23 patients with GBM who received 30 fractions of simultaneous integrated boost IMRT. PTV60 received 2 Gy daily to the tumor bed or residual tumor while PTV54 received 1.8 Gy daily to the surrounding edema. Concurrent TMZ (75 mg/m^2) daily and BEV (10 mg/kg every 2 weeks) were given during radiation therapy. One month after RT completion, adjuvant TMZ (150 mg/m^2 × 5 days) and BEV were delivered monthly until progression or 12 months total.

Results

With a median follow-up of 12 months, the median disease-free and overall survival were not reached. Four patients discontinued therapy due to toxicity for the following reasons: bone marrow suppression (2), craniotomy wound infection (1), and pulmonary embolus (1). Five patients had grade 2 or 3 hypertension managed by oral medications. Of the 12 patients with tumor recurrence, 7 suffered distant failure with either subependymal (5/12; 41%) or deep white matter (2/12; 17%) spread detected on T2 FLAIR sequences. Five of 12 patients (41%) with a recurrence demonstrated evidence of GAD enhancement. The patterns of failure did not correlate with extent of resection or number of adjuvant cycles.

Conclusions

Treatment of GBM patients with concurrent radiation, BEV, and TMZ was well tolerated in the current study. The majority of patients experienced an out-of-field pattern of failure with radiation, BEV, and TMZ which has not been previously reported. Further investigation is warranted to determine whether BEV alters the underlying tumor biology to improve survival. These data may indicate that the currently used clinical target volume thought to represent microscopic disease for radiation may not be appropriate in combination with TMZ and BEV.

【 授权许可】

   
2013 Shields et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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