scholarly journals RT-1 Treatment results of salvage gamma knife stereotactic radiosurgery and bevacizumab (AVAgamma therapy) for recurrent malignant glioma

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi14-vi15
Author(s):  
Kenichi Sato ◽  
Taku Asanome ◽  
Yuuki Ishida ◽  
Hironori Sugio ◽  
Hirohiko Nakamura
Keyword(s):  
Malignant Glioma ◽  
Gamma Knife ◽  
Initial Treatment ◽  
Progression Free Survival ◽  
Recurrent Malignant Glioma ◽  
Treatment Results ◽  
Life Prognosis ◽  
Irradiation Volume ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract Purpose: We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent malignant glioma. Subjects: From August 2013 to January 2021, 71 patients (Grade 2:8 patients, Grade3:16 patients, Grade 4:47 patients) with recurrent malignant glioma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 55.7 years, with 44 men and 27 women. The tumor volume is 150 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of the gamma knife was 15 ml or less, the marginal dose was 20 to 26 Gy, and when the irradiation volume was 15 ml or more, the marginal dose was 12 to 15 Gy in two divided doses.The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK. Methods: Median progression-free survival (mPFS) from AVAgamma treatment, median survival (mOS), and mOS from initial treatment were examined and compared with mOS in the RPA classification of recurrent glioma. Results: In relapsing glioma RPA classification, NABTT CNC class 2 mOS is 17.2 months, class 3 mOS is 3.8 months, class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 18 months in class 3, 11 months in class 5, 9 months in class 6. The survival time has been extended in class3, class5, class6. Discussion: By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged. Conclusion: AVAgamma therapy is thought to prolong the survival of recurrent malignant glioma and play an important role as salvage treatment.

scholarly journals RT-01 TREATMENT RESULTS OF SALVAGE GAMMA KNIFE STEREOTACTIC RADIOSURGERY AND BEVACIZUMAB (AVAGAMMA THERAPY) FOR RECURRENT GLIOBLASTOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii21-ii21
Author(s):  
Kenichi Sato ◽  
Masami Takanashi ◽  
Yoshimaru Ozaki ◽  
Taku Asanome ◽  
Hironori Sugio ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Initial Treatment ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Treatment Results ◽  
Free Survival ◽  
Life Prognosis ◽  
Irradiation Volume ◽  
The Mean ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract PURPOSE We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent glioblastoma. SUBJECTS From August 2013 to April 2018, 42 patients (183 lesions) with recurrent glioblastoma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 61.1 years, with 25 men and 17 women. The tumor volume is 100 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of GK is 15 ml or less, a single irradiation with a boundary dose of 20 Gy was performed, and when the irradiation volume was 15 ml or more, a single irradiation boundary dose was divided into two divided irradiations of 12 to 15 Gy. The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK. METHODS Median progression-free survival (mPFS), 6-month progression-free survival (PFS-6m), 6-month survival (OS-6m), median survival (mOS) from treatment with AVAgamma Considered mOS from initial treatment. [Results]: The mPFS from AVAgamma therapy was 5 months, PFS-6m was 37%, OS-6m was 84%, and mOS was 9 months. The mOS from initial treatment were 25 months. In relapsing glioma RPA classification, NABTT CNC class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 9 months in class 5, 9 months in class 6. The survival time has been extended. DISCUSSION By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged. CONCLUSION AVAgamma therapy is thought to prolong the survival of recurrent glioblastoma and play an important role as salvage treatment.

scholarly journals RT-01 Treatment results of salvage gamma knife and bevacizumab (AVAgamma therapy) for recurrent glioblastoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii11-ii11
Author(s):  
Kenichi Sato ◽  
Taku Asanome ◽  
Yuuki Ishida ◽  
Hironori Sugio ◽  
Yoshimaru Ozaki ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Initial Treatment ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Treatment Results ◽  
Free Survival ◽  
Life Prognosis ◽  
Irradiation Volume ◽  
The Mean ◽  
Extended Discussion

Abstract Purpose: We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent glioblastoma. Subjects: From August 2013 to April 2020, 44 patients (88 lesions) with recurrent glioblastoma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 61.5 years, with 26 men and 18 women. The tumor volume is 150 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of GK is 15 ml or less, a single irradiation with a boundary dose of 20 to 26 Gy was performed, and when the irradiation volume was 15 ml or more, a single irradiation boundary dose was divided into two divided irradiations of 12 to 15 Gy. The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK. Methods: Median progression-free survival (mPFS), 6-month progression-free survival (PFS-6m), 6-month survival (OS-6m), median survival (mOS) from treatment with AVAgamma Considered mOS from initial treatment. Results: The mPFS from AVAgamma therapy was 5 months, PFS-6m was 37%, OS-6m was 79%, and mOS was 9 months. The mOS from initial treatment were 25 months. In relapsing glioma RPA classification, NABTT CNC class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 9 months in class 5, 9 months in class 6. The survival time has been extended. Discussion: By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged. Conclusion: AVAgamma therapy is thought to prolong the survival of recurrent glioblastoma and play an important role as salvage treatment.

Bevacizumab plus etoposide among recurrent malignant glioma patients: Phase II study final results

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2046-2046
Author(s):  
D. Reardon ◽  
A. Desjardins ◽  
J. J. Vredenburgh ◽  
S. Gururangan ◽  
K. B. Peters ◽  
...  
Keyword(s):  
Malignant Glioma ◽  
Intracranial Hemorrhage ◽  
Progression Free Survival ◽  
Therapeutic Benefit ◽  
Primary Outcome Measure ◽  
Recurrent Malignant Glioma ◽  
Neutralizing Monoclonal Antibody ◽  
Grade 3 ◽  
Endothelial Growth Factor

2046 Background: Significant therapeutic benefit has been observed among recurrent malignant glioma (MG) patients treated with bevacizumab (BV), a neutralizing monoclonal antibody to vascular endothelial growth factor (VEGF) with or without chemotherapy. In this study, we evaluate the efficacy of BV plus etoposide (E), a topoisomerase inhibitor, among recurrent MG patients. Methods: Recurrent patients with no more than three prior episodes of recurrence are eligible, while those with prior BV treatment or prior intracranial hemorrhage are excluded. The primary outcome measure is 6 month progression-free survival (6-PFS). BV is dosed at 10 mg/kg intravenously every other week. Etoposide is orally administered daily (50 mg/m2) for days 1–21 of each 28-day cycle. Results: Fifty-nine patients (GBM, n = 27; grade 3 MG, n = 32) with a median of 2 prior progressions have enrolled. With a median follow-up of 45 weeks, median overall survival (OS) for GBM and grade 3 MG patients were 46 and 47 weeks, while the 6-PFS is 44% and 40.6%, respectively. The most common toxicities were neutropenia (41%), fatigue (22%), and infection (20%) and were grade 2 in most cases. One patient developed grade 1 intracranial hemorrhage and 1 patient had a grade 4 GI perforation. Conclusions: Combination of bevacizumab and etoposide is well tolerated in recurrent MG patients and is associated with encouraging anti-tumor benefit. Accrual is complete and an update of further treatment and follow-up will be presented. No significant financial relationships to disclose.

Phase II study of high central dose Gamma Knife radiosurgery and marimastat in patients with recurrent malignant glioma

2002 ◽  
Vol 54 (5) ◽  
pp. 1397-1404 ◽  
Author(s):  
David A Larson ◽  
Michael Prados ◽  
Kathleen R Lamborn ◽  
Vernon Smith ◽  
Penny K Sneed ◽  
...  
Keyword(s):  
Malignant Glioma ◽  
Gamma Knife ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Gamma Knife Radiosurgery ◽  
Recurrent Malignant Glioma

scholarly journals Lack of Efficacy of Bevacizumab Plus Irinotecan in Children With Recurrent Malignant Glioma and Diffuse Brainstem Glioma: A Pediatric Brain Tumor Consortium Study

2010 ◽  
Vol 28 (18) ◽  
pp. 3069-3075 ◽  
Author(s):  
Sridharan Gururangan ◽  
Susan N. Chi ◽  
Tina Young Poussaint ◽  
Arzu Onar-Thomas ◽  
Richard J. Gilbertson ◽  
...  
Keyword(s):  
Malignant Glioma ◽  
Mononuclear Cells ◽  
Single Agent ◽  
Survival Rates ◽  
Growth Factor Receptor ◽  
Pediatric Brain Tumor ◽  
Progression Free Survival ◽  
Brainstem Glioma ◽  
Recurrent Malignant Glioma ◽  
Peripheral Blood Mononuclear

Purpose A phase II study of bevacizumab (BVZ) plus irinotecan (CPT-11) was conducted in children with recurrent malignant glioma (MG) and intrinsic brainstem glioma (BSG). Patients and Methods Eligible patients received two doses of BVZ intravenously (10 mg/kg) 2 weeks apart and then BVZ plus CPT-11 every 2 weeks until progressive disease, unacceptable toxicity, or a maximum of 2 years of therapy. Correlative studies included diffusion weighted and T1 dynamic contrast–enhanced permeability imaging, BVZ pharmacokinetics, and estimation of vascular endothelial growth factor receptor 2 (VEGFR-2) phosphorylation in peripheral blood mononuclear cells (PBMC) after single-agent BVZ. Results Thirty-one evaluable patients received a median of two courses of BVZ plus CPT-11 (range, 1 to 19). No sustained responses were observed in either stratum. Median time to progression for all 34 eligible patients enrolled was 127 days for MG and 71 days for BSG. Progression-free survival rates at 6 months were 41.8% and 9.7% for MG and BSG, respectively. Toxicities related to BVZ included grade 1 to 3 fatigue in seven patients, grade 1 to 2 hypertension in seven patients, grade 1 CNS hemorrhage in four patients, and grade 4 CNS ischemia in two patients. The mean diffusion ratio decreased after two doses of BVZ in patients with MG only. Vascular permeability parameters did not change significantly after therapy in either stratum. Inhibition of VEGFR-2 phosphorylation in PBMC was detected in eight of 11 patients after BVZ exposure. Conclusion BVZ plus CPT-11 was well-tolerated but had minimal efficacy in children with recurrent malignant glioma and brainstem glioma.

scholarly journals Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases: The MD Anderson experience

2015 ◽  
Vol 2 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Khinh Ranh Voong ◽  
Benjamin Farnia ◽  
Qianghu Wang ◽  
Dershan Luo ◽  
Mary F. McAleer ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Progression Free Survival ◽  
Lesion Size ◽  
Significant Treatment ◽  
Kaplan Meier ◽  
Treatment Dose ◽  
Md Anderson ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract Background Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results Median follow-up was 5.5 months (range, 0.2–48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003–5.58 cm3). Median treatment dose was 16 Gy (range, 10–20 Gy) prescribed to 50% isodose line (range, 40%–86%). Crude LC was 94% (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95% CI, 5.6–9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P < .001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36% (10/28) resolved after SRS and 50% (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95% CI, 2.7–4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8%, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions GK_SRS is associated with high LC (94%) and low toxicity (8%) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.

Post-bevacizumab treatment and clinical outcomes in recurrent malignant glioma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2098-2098
Author(s):  
Yongjun Cha ◽  
Yu Jung Kim ◽  
Tae Min Kim ◽  
Seung Hong Choi ◽  
Se-Hoon Lee ◽  
...  
Keyword(s):  
Malignant Glioma ◽  
Disease Progression ◽  
Clinical Outcomes ◽  
Progression Free Survival ◽  
Magnetic Resonance Images ◽  
Intrathecal Methotrexate ◽  
Recurrent Malignant Glioma ◽  
Free Survival ◽  
Bevacizumab Treatment

2098 Background: Bevacizumab (Bev) and irinotecan combination therapy is effective against recurrent malignant glioma. However, post-Bev treatment and its clinical outcomes are not well investigated. Methods: We identified 103 consecutive recurrent malignant glioma patients who received Bev plus irinotecan at our institutions.Clinical records and magnetic resonance images were reviewed. Response and progression were assessed by RANO criteria. Results: Bev and irinotecan treatment produced response rate of 37.9% (95% CI, 29.1-47.5%). At a median follow-up time of 41 weeks, the median progression-free survival (PFS) was 17.1 weeks (95% CI, 14.3-20.0), and 6-month PFS (6M-PFS) was 27.8% (95% CI, 18.4-37.2). The median overall survival (OS) was 33.4 weeks (95% CI, 27.8-39.1). Response predicted for superior PFS (25.0 weeks vs. 11.0 weeks, p < .001) and OS (45.9 weeks vs. 26.7 weeks, p < .001). A total of 93 patients discontinued Bev treatment and the reasons for discontinuation were: disease progression in 59 (63.4%), toxicities in 4 (4.3%), physician’s decision in 5 (5.4%), patient’s refusal to further treatment in 25 (26.9%). The median OS was 26.7 weeks in 59 patients who discontinued Bev due to disease progression, and 45.7 weeks in 34 patients who discontinued Bev for reasons other than disease progression (p < .001). Among 85 patients who progressed after Bev, 42 (49.4%) received further therapy: chemotherapy in 32 (37.6%), radiotherapy in 9 (10.6%), and surgery in 1 (1.2%). Further chemotherapy regimens included temozolomide (31.2%), ACNU/CDDP (25.0%), Bev reintroduction (18.8%), erlotinib (12.5%), PCV (9.4%), and intrathecal methotrexate (3.1%). The median survival time after Bev failure was 15.6 weeks (95% CI, 13.3-17.8). Patients who received further therapy showed longer median OS (18.6 weeks vs. 12.9 weeks, p < .001). In patients who received chemotherapy, the median PFS and OS was 6.6 weeks and 20.6 weeks, respectively. Conclusions: Prognosis after Bev failure was poor. Proper selection of patients who may benefit from further treatment is warranted.

Temozolomide plus interferon-β for recurrent malignant glioma patients: Experience of 28 cases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e13037-e13037
Author(s):  
Zhong-ping Chen ◽  
Qun-ying Yang ◽  
Cheng-cheng Guo
Keyword(s):  
Malignant Glioma ◽  
Objective Response ◽  
Progression Free Survival ◽  
High Grade Glioma ◽  
Response Assessment ◽  
Complete Response ◽  
Recurrent Malignant Glioma ◽  
Interferon Β ◽  
Patients Experience ◽  
Grade Iii

e13037 Background: Previous studies showed that interferon-β may enhance chemosensitivity of temozolomide (TMZ) and nitrosoureas. The present study was to evaluate the efficiency and side effects of TMZ plus INF-β in recurrent malignant glioma patients. Methods: Patients (age≥18 years) with grade III-IV glioma that was progressive or recurrent after prior standard radiotherapy plus TMZ chemotherapy were eligible for the study. Patients were scheduled to receive INF-β 3MU subcutaneous injections on days 1, 3 and 5, while TMZ 200mg/m2orally on days 2 to 6, of a 4-week cycle until tumor progression or unacceptable toxicity. Tumor response was assessed by MRI every 8 weeks. The primary end point was objective response (complete response [CR] plus partial response [PR]) by Response Assessment in Neuro-Oncology Working Group (RANO) criterion. Secondary end points included progression free survival (PFS), overall survival (OS), and toxicity. Results: From July of 2010 to October of 2012, 28 patients were assessed (16 GBM and 12 grade III glioma). There were 22 males and 6 females, and the median age was 44.5 years (ranged from 22 to 73). The median KPS was 80 (70`100). Radiographic responses were noticed in 35.7% (10 of 28) of patients. There was none CR, but 10 PR, 14 stable disease (SD) and 4 progressive disease (PD). The median PFS was 6.0 months (95% CI 3.9-8.0),the median OS was not availability. The most common toxicities include grade±-2 neutropenia(4 cases), thrombocytopenia (3 cases), nausea and vomiting (3 case), fatigue (8 cases) and liver malfunction (3 cases). Grade III or ‡W toxicities were uncommon. Conclusions: Temozolomide plus INF-β has moderate efficacy for recurrent high grade glioma with acceptable toxicity, and thus worth further investigation.

scholarly journals Treatment With Bevacizumab Plus Carboplatin for Recurrent Malignant Glioma

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Eric M. Thompson ◽  
Edit Dosa ◽  
Dale F. Kraemer ◽  
Edward A. Neuwelt
Keyword(s):  
Malignant Glioma ◽  
Progression Free Survival ◽  
World Health ◽  
Karnofsky Performance Score ◽  
Recurrent Malignant Glioma ◽  
First Recurrence ◽  
Grade 3 ◽  
Health Organization ◽  
T2 Weighted Images

Abstract OBJECTIVE To estimate overall survival (OS), progression-free survival (PFS), imaging responses, and toxicities of bevacizumab plus carboplatin for the treatment of recurrent malignant glioma. The secondary objective was to estimate the agreement between postcontrast T1-weighted and T2-weighted magnetic resonance imaging. METHODS A retrospective analysis of 9 patients who received bevacizumab (10 mg/kg intravenously) and carboplatin (AUC 5 intravenously) for recurrent malignant glioma (World Health Organization grades III and IV) is presented. Eight of 9 patients received this regimen at first recurrence. RESULTS The median age and Karnofsky performance score were 51 years and 70, respectively. For the 5 patients with grade III gliomas, the median PFS was 126 days, whereas median OS was not attained at 517 days of follow-up. Six-month PFS was 40%, whereas 6-month OS was 60%. For the 4 patients with grade IV gliomas, the median PFS was 216 days, whereas the median OS was not attained at 482 days of follow-up. Six-month PFS was 50%, whereas 6-month OS was 75%. The agreement between contrast-enhanced T1-weighted and T2-weighted images to determine recurrence was moderate (kappa = 0.5714). Three patients had grade 3 and 4 toxicities including hyponatremia and thrombocytopenia. CONCLUSION Patients who received the combination of bevacizumab plus carboplatin for recurrent malignant glioma had reasonable PFS, OS, and toxicities. The median OS in our series is promising at well over 1 year. Agreement between postcontrast T1- and T2-weighted images is only moderate in the context of bevacizumab therapy.

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