Clinical Trial Finder

Inclusion Criteria:

• - Previous pathologic confirmation of a tumor treated with radiation to the brain completed at least 6 months prior to the start of planned reirradiation, except for patients with tumors that are routinely diagnosed without biopsy, including germinoma and optic pathway glioma; patients with a history of cranial irradiation for leukemia are eligible.

• - Patient must have received one and only one previous course of radiation to the brain, delivered at 1.5 - 2.5 Gy/fraction, one fraction per day.

• - Multidisciplinary evaluation of the patient must be performed with a consensus recommendation for reirradiation.

• - Patient may not receive concurrent chemotherapy with reirradiation, other than temozolomide or bevacizumab given at the discretion of the treating neuro-oncologist.

• - Patient must have imaging findings within the last 3 months consistent with recurrent disease in the brain; pathologic diagnosis of recurrence is not required.

• - Patient may undergo surgical resection prior to reirradiation.

• - Dose-volume histogram data and cross-sectional imaging from previous radiation must be obtained; electronic dosimetry records in Digital Imaging and Communications in Medicine (DICOM) format from previous radiation are strongly preferred.

• - Signed informed consent by patient and/or parents or legal guardian.

• - Lansky/Karnofsky performance status score of 50-100.

Exclusion Criteria:

- Patients with recurrent diffuse intrinsic pontine glioma (DIPG) - Pregnancy

PRIMARY OBJECTIVES:

• I. To estimate the rate of grade 3 or higher central nervous system (CNS) necrosis 6 months after reirradiation of the brain for recurrent tumor.

SECONDARY OBJECTIVES:

• I. To evaluate acute and late toxicities of reirradiation.

• II. To evaluate longitudinal changes in symptom burden of patients undergoing reirradiation.

• III. To use Advanced Brain Tumor Imaging (ABTI) to evaluate changes in the brain after reirradiation, including progression, pseudoprogression, and radionecrosis.

• IV. To estimate progression-free survival (PFS) and overall survival (OS) following reirradiation.

OUTLINE: Patients are assigned to 1 of 2 arms based on age. ARM I (Age 0-18 years): Patients undergo radiation therapy with conventional fractionation and dose constraints. Treatment continues for up to 6 weeks in the absence of disease progression or unacceptable toxicity. ARM II (Age > 18 years): Patients undergo radiation therapy with conventional fractionation and dose constraints. Patients also receive bevacizumab concurrently at the discretion of the treating neuro-oncologist. Treatment continues for up to 6 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 1 month, then every 2 months for 1 year, then every 3 months for 1 year.

Arms

Experimental: Arm I (conventional fractionation)

Patients undergo radiation therapy with conventional fractionation and dose constraints. Treatment continues for up to 6 weeks in the absence of disease progression or unacceptable toxicity.

Active Comparator: Arm II (conventional fractionation, bevacizumab)

Patients undergo radiation therapy with conventional fractionation and dose constraints. Patients also receive bevacizumab concurrently at the discretion of the treating neuro-oncologist. Treatment continues for up to 6 weeks in the absence of disease progression or unacceptable toxicity.

Interventions

Biological: - Bevacizumab

Other: - Quality-of-Life Assessment

Ancillary studies

Radiation: - Radiation Therapy

Undergo radiation therapy with conventional fractionation