Radiation Oncology/CNS/High grade glioma/Recurrence

High Grade Glioma: Recurrences For the topic of Pseudoprogression please see Pseudoprogression at the Overview page Epidemiology Salvage RT Review; 2007 17760992 -- "Radiotherapeutic alternatives for previously irradiated recurrent gliomas." (Combs SE, BMC Cancer. 2007 Aug 30;7(1):167) Michigan, 2002 (1996-99) - 11896114 — "Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy." Chan JL et al. J Clin Oncol. 2002 Mar 15;20(6):1635-42. Retrospective. 34 pts. Pts with HGG treated to 90 Gy using IMRT. Defined recurrences as central (>95% of volume in high dose region), in-field(80% to 95%), marginal (20% to 80%), and distant (<20%). For planning, used GTV=enhancing tumor (no edema). PTV1=0.5 cm margin, PTV2=1.5 cm, PTV3=2.5 cm. 90 Gy prescribed to PTV1, 70 Gy to PTV2, 60 Gy to PTV3. 67% had recurrence. 78% were central, 13% in-field, 9% marginal, 0% distant. Conclusion: predominant treatment failure is local/central. This suggests that close margins in conformal treatment do not increase the risk of marginal or distant recurrences. Salvage chemotherapy Duke, 2007 (2005-2006) 17947719 -- "Bevacizumab plus irinotecan in recurrent glioblastoma multiforme." (Vredenburgh JJ, J Clin Oncol. 2007 Oct 20;25(30):4722-9.) Phase II. 35 patients. Initial regimen bevacizumab 10 mg/kg with irinotecan. Then bevacizumab 15 mg/kg and irinotecan Outcome: 6-month PFS 46%, OS 77%. Response rate 95% and significant improvements in cognitive and functional status Toxicity: 1 CNS hemorrhage, 4 thromboembolic events Conclusion: Bevacizumab/irinotecan effective for recurrent disease, with moderate toxicity