Re-irradiation combined with bevacizumab in the treatment of glioblastoma recurrence

Abstract

Background. Glioblastoma (GB) remains an aggressive disease with a poor prognosis. despite a comprehensive approach to the treatment of the primary disease, recurrence is almost inevitable. There is still no standard of care for GB recurrence, and many guidelines recommend treating these patients within clinical trials. There are various treatment options available. They include surgery, radiation therapy, systemic or regional chemotherapy or targeted therapy, various immunotherapy strategies, low- and medium-frequency electric fields, and their combinations. The combination of two non-invasive techniques: re-irradiation and systemic targeted therapy remains the most commonly used approach in this group of patients, the potential of which has not been fully realized. The aim of the study was to analyze the literature data on the use of the combination of re-irradiation with bevacizumab as a therapeutic option in patients with GB. Material and Methods. Literature search was performed using Medline, Cochrane Library, E-library, Scopus, PubMed and Google Scholar databases. Results. The current state of the problem was determined, the data available to date on the use of repeated radiotherapy with competitive and/or adjuvant bevacizumab in the treatment of GB recurrence were summarized and analyzed, different regimens of this approach were compared, and the prospects and possible ways of solving the existing problems of this therapeutic option were described. Conclusion. Re-irradiation with concomitant administration of bevacizumab may provide safer treatment of GB recurrence, including large-volume glioblastoma, with acceptable toxicity, in particular radiation necrosis, especially when an appropriate fractionation schedule is used.

Keywords

• glioblastoma recurrence
• repeated radiation therapy
• proton therapy
• targeted therapy
• relapse of high-grade glioma