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Objective: Safety and activity in the combination of Radiotherapy with
Bevacizumab in recurrent malignant gliomas.
Materials and Methods: Patients in case of recurrence from malignant
gliomas who failed to standard treatment received Bevacizumab (10
mg/kg i.v.) every two weeks until tumorprogression and a
hypofractionate or normal fractionated radiotherapy. The interval
between the two radiotherapy treatments was at least 4 months. The
median physical doses of the first and second radiation course were
40.00 - 60.00 Gy and 39.00 - 60.00 Gy, respectivly.
Results: 4 consecutive Patients with relapse received 2 cycles
Bevacizumab prior to Re-irradiation and underwent a repeat MRI-Scan
for RT planing. Patients who responded or had a stable disease were
proceeded to radiation therapy. Critical structures like the optic chiasm
were excluded and the dose to the re-irradiated target volume was
restricted to a cumulative dose of 110 Gy of the first and second
radiation course. Until now no necrosis is seen in this cohort and all
patients responded to the therapy. No Grade 3-4 acute toxicity
developed, haematologic and non haematologic toxicities were transient.
The systemic therapy is continuing and all patients are still alive.
Conclusion: The combination of Bevacizumab and Re-irradiation in
recurrent gliomas is safe and well tolerated. Care should be taken of
unexpected neurotoxicity because of possibly impaired repair of
radiation induced sub-lethal damage by Bevacizumab.