Central Nervous System

PV QA 2 - Poster Viewing Q&A 2

MO_11_2738 - Low dose Bevacizumab in treatment of radiation necrosis post IGRT with Cyberknife boost with Temozolamide for Glioma patients

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Low dose Bevacizumab in treatment of radiation necrosis post IGRT with Cyberknife boost with Temozolamide for Glioma patients
P. S. Sridhar1, K. Roopesh1, N. Madhusudhan1, G. H. Abilash1, N. Radheshyam2, M. Hamid3, S. Kundavai1, S. S. Shivalingappa4, K. A. R. Avinash2, I. Desai5, M. A. Kumar6, S. Vittal7, R. S. Bilimagga8, G. Kilara1, S. Revannasiddaiah9, R. Deshpande10, A. Ram11, and B. ajai Kumar4; 1Health Care Global Enterprises Ltd, Bangalore, India, 2health care global enterprises, bangalore, India, 3HCG RMC, Daresalam, Tanzania, United Republic of, 4Healthcare Global Enterprises, Bangalore, India, 5health care global enterprises ltd, BENGALURU, India, 6healthcare Global enterprises Ltd, bangalore, India, 7healthcare global enterprises, bangalore, India, 8Healthcare Global Enterprises Ltd., Bangalore, India, 9HCG Tower, haldwani, India, 10Fortis hospital, Bangalore, India, 11healthcare global, bangalore, India

Purpose/Objective(s): Newer radiation techniques such as IMRT/IGRT/Tomotherapy and particle radiation therapy, has made it possible to provide high absorbed doses to tumor tissue, achieving good rates of tumor control in high grade gliomas. However, the use of high dose radiation for the treatment of malignant brain tumors is typically at the expense of greater rates of radiation necrosis within the treatment volume. This leads compromised quality of life and steroid dependence. Recently, bevacizumab (a humanized murine monoclonal antibody against VEGF) has been suggested as a new treatment modality for brain radionecrosis. Higher doses of Bevacizumab is in practice, increasing the risks of bleeding a hypertension. Primary objective of this study was to assess the efficacy of low dose bevacizumab to reduce the radiation necrosis and edema caused by primary chemoradiation for gliomas. Secondary objective was to assess the symptomatic improvement and steroid reduction by low dose bevacizumab

Materials/Methods: The study retrospectively analysed data of 13 patients who underwent primary radiation (GTV Dose-54Gy/25frs) followed by robotic radiosurgery boost (Dose-10-16Gy/2frs) along with concurrent chemotherapy with Cap TMZ 100mg for 45days and monthly adjuvant TMZ. Low dose (100mg) bevcizumab was started upon necrosis seen on the MRI and development of symptoms. MRI was done every 3 months and changes in T1 contrast and T2 flair volumes were assessed.Steroid reduction and symptomatic improvement were also recorded.

Results: Median follow up period post CTRT was 15 months. Median follow up post first dose of bevacizumab was 7 months. Median time taken to develop radiation necrosis post CTRT was 6 months. Post bevacizumab all patients except one had good reduction in necrosis and T2 flair component and T1 contrast enhancing lesion. Mean T1 contrast enhancement and T2 flair before and after bevacizumab decreased significantly as shown in the table and all patients had symptomatic improvement and reduction in steroid dose.
Variable N Pre Bevacizuman Post Bevacizumab p
T1 Contrast 13 47.4±42.17 22.37±17.44 0.028
T2 Flair 13 248.75±136.63 151.13±116.31 0.004

Conclusion: As opposed to the currect practice of 10-15mg/m2 resulting in doses above 600mg per dose, low dose bevacizumab at a flat dose of 100mg is equally effective in reducing radiation necrosis, edema, symptoms and steroid dose.

Author Disclosure: P. Sridhar: None. N. Madhusudhan: None. G.H. Abilash: None. N. Radheshyam: None. M. Hamid: None. S. Kundavai: None. S.s. Shivalingappa: None. S. Vittal: None. R.S. Bilimagga: Honoraria; Health Care Global Enterprises Limited, INDIA. Stock; Health Care Global Enterprises INDIA. Past President; AROI. A. Ram: None.

Send Email for Papaiah Susheela Sridhar


Assets

MO_11_2738 - Low dose Bevacizumab in treatment of radiation necrosis post IGRT with Cyberknife boost with Temozolamide for Glioma patients



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Low dose Bevacizumab in treatment of radiation necrosis post IGRT with Cyberknife boost with Temozolamide for Glioma patients