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GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOLLOWED BY BEVACIZUMAB FOR RECURRENT GLIOBLASTOMA
Introduction, Objectives, Methods, Results, and Conclusion.
INTRODUCTION: Stereotactic radiosurgery (SRS) represents a salvage therapeutic modality for recurrent Glioblastomas. Although there is no clear benefit in overall survival, recent publications suggest that the concomitant use of bevacizumab may reduce pos-irradiation complications.
OBJETIVES: evaluate the clinical characteristics and patterns of the findings in magnetic resonance imaging (MRI) in a series of patients with focal glioblastoma recurrence treated with gamma knife SRS plus bevacizumab.
METHODS: post-treatment MRI of five patients from our series were analyzed. Findings were divided in progression and non-progression and categorized according to the patterns found. Additional outcomes were overall survival (OR) and progression free survival (PFS).
RESULTS: Standard and advanced MRI was performed in all cases. Standard imaging showed similar findings in recurrence disease and post-therapeutic changes, with heterogenous contrast enhancement and vasogenic edema. Advanced imaging was more accurate, with recurrence showing restricted diffusion of the enhancing lesion with high perfusion (rCBV and Ktrans) and elevated choline/NAA ratios.
CONCLUSION: Post-therapeutic neuroimaging is challenging and time-consuming in high grade gliomas, but advanced techniques may be helpful in differentiate residual/recurrence neoplasm form post-chemoradiotheraphy findings.
Keywords (separated by comma on a single line)
Gamma Knife; malignant gliomas; glioblastoma; bevacizumab
BERNARDO CORREA DE ALMEIDA TEIXEIRA, ERASMO BARROS DA SILVA JR, MAURICIO COELHO NETO, JOHNNY FRANCISCO CAMARGO, DANIEL BENZECRY DE ALMEIDA, HAMZAH YOUSSEF SMAILI, RICARDO RAMINA