How do molecular and clinical factors guide personalized selection of HSRT dose fractionation regimens with bevacizumab in recurrent high-grade gliomas?

Multivariate analysis identifying HSRT dose fractionation, tumor grade, IDH mutation, and 1p/19q codeletion as significant predictors of progression-free survival (PFS) in recurrent high-grade glioma strongly supports a shift toward biomarker-driven stratification in future trials. These findings underscore the biological heterogeneity of recurrent gliomas and suggest that integrating molecular markers with clinical and dosimetric factors can enable more personalized treatment approaches. IDH-mutant and 1p/19q-codeleted tumors, in particular, may derive greater benefit from more aggressive HSRT regimens when combined with bevacizumab, while IDH-wildtype or high-grade tumors might require more cautious dosing strategies to balance efficacy a...

Is there a size limitation to SRT for recurrent GBM? I traditionally have always done the 35/10 Fogh regimen for anything over 3 cm. However, now with this data, I'm feeling I need to be a bit more aggressive with fractionated radiosurgery. Anyone doing 30/5 for 5 cm+ recurrences with Avastin?