Open Access

Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy

  • Authors:
    • Arsela Prelaj
    • Sara Elena Rebuzzi
    • Massimiliano Grassi
    • Julio Rodrigo Giròn Berrìos
    • Silvia Pecorari
    • Carmela Fusto
    • Carla Ferrara
    • Maurizio Salvati
    • Valeria Stati
    • Silverio Tomao
    • Vincenzo Bianco
  • View Affiliations

  • Published online on: October 16, 2018     https://doi.org/10.3892/mco.2018.1745
  • Pages: 49-57
  • Copyright: © Prelaj et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The therapeutic management of recurrent malignant gliomas (MGs) is not determined. Therefore, the efficacy of a multimodal approach and a combination systemic therapy was investigated. A retrospective analysis of 26 MGs patients at first relapse treated with multimodal therapy (chemotherapy plus surgery and/or reirradiation) or chemotherapy alone was performed. Second-line chemotherapy consisted of fotemustine (FTM) in combination with bevacizumab (BEV) (cFTM/BEV) or followed by third-line BEV (sFTM/BEV). Subgroup analyses were performed. Multimodal therapy provided a higher overall response rate (ORR) (73 vs. 47%), disease control rate (DCR) (82 vs. 67%), median progression-free survival (mPFS) (11 vs. 7 months; P=0.08) and median overall survival (mOS) (13 vs. 8 months; P=0.04) compared with chemotherapy. Concomitant FTM/BEV resulted in higher ORR (84 vs. 36%), DCR (92 vs. 57%), mPFS (10 vs. 5 months; P=0.22) and mOS (11 vs. 5.2 months; P=0.15) compared with sFTM/BEV. Methylated patients did not experience additional survival benefits with multimodality treatment but had higher mPFS (10 vs 7.1 months; P=0.33) and mOS (11 vs. 8 months; P=0.33) with cFTM/BEV. Unmethylated patients experienced the greatest survival benefit with the multimodal approach (mPFS: 10 vs. 5 months; mOS 11 vs 6 months; both P=0.02) and cFTM/BEV (mPFS: 5 vs. 2 months; mOS 6 vs. 3.2 months; both P=0.01). In conclusion, in recurrent MGs, multimodal therapy and cFTM/BEV provide survival and response benefits. Methylated patients benefit from a cFTM/BEV but not from a multimodal approach. Notably, unmethylated patients had the highest survival benefit with the two strategies.
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January 2019
Volume 10 Issue 1

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APA
Prelaj, A., Rebuzzi, S.E., Grassi, M., Giròn Berrìos, J.R., Pecorari, S., Fusto, C. ... Bianco, V. (2019). Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy. Molecular and Clinical Oncology, 10, 49-57. https://doi.org/10.3892/mco.2018.1745
MLA
Prelaj, A., Rebuzzi, S. E., Grassi, M., Giròn Berrìos, J. R., Pecorari, S., Fusto, C., Ferrara, C., Salvati, M., Stati, V., Tomao, S., Bianco, V."Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy". Molecular and Clinical Oncology 10.1 (2019): 49-57.
Chicago
Prelaj, A., Rebuzzi, S. E., Grassi, M., Giròn Berrìos, J. R., Pecorari, S., Fusto, C., Ferrara, C., Salvati, M., Stati, V., Tomao, S., Bianco, V."Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy". Molecular and Clinical Oncology 10, no. 1 (2019): 49-57. https://doi.org/10.3892/mco.2018.1745