Bevacizumab With or Without Radiation Therapy in Treating Patients With Recurrent Glioblastoma

Inclusion Criteria

• •Patients who did not have recent surgery for their glioblastoma must have shown unequivocal radiographic evidence for tumor progression by contrast-enhanced magnetic resonance imaging (MRI) scan (or computed tomography \[CT\] scan for patients with non-compatible devices) CT scan within 21 days prior to registration.
• •\* Note: Patients who did have surgery with a post-operative contrast-enhance scan falling outside the 5 week window prior to registration, must have a repeat MRI scan (or CT scan for patients with non-compatible devices) within 21 days prior to registration.
• •* New areas of tumor outside the original radiotherapy fields as determined by the investigator, or
• •* Histologic confirmation of tumor through biopsy or resection, or
• •* Nuclear medicine imaging, magnetic resonance (MR) spectroscopy, or MR perfusion imaging consistent with true progressive disease, rather than radiation necrosis obtained within 28 days of registration AND an interval of at least 90 days between completion of radiotherapy and registration
• •Patients unable to undergo MR imaging because of non-compatible devices can be enrolled provided CT scans are obtained and are of sufficient quality; patients without non-compatible devices may not use CT scans performed to meet this requirement
• •Prior history of standard dose CNS radiation of 60 Gy in 30 fractions or 59.4 Gy in 1.8 Gy fractions, or equivalent or lower doses
• •Patients who have received prior treatment with non-standard radiation therapy (RT) dose and fractionation, interstitial brachytherapy, stereotactic radiosurgery, etc. are eligible
• •Patients must have recovered from the toxic effects of prior therapy, and there must be a minimum time of 28 days prior to registration from the administration of any investigational agent or prior cytotoxic therapy with the following exceptions:
• •* 14 days from administration of vincristine
• •* 42 days from administration of nitrosoureas
• •* 21 days from administration of procarbazine
• •Patients having undergone recent resection of their glioblastoma (within 5 weeks prior to registration) must have recovered from the effects of surgery; for CNS related core or needle biopsies, a minimum of 7 days must have elapsed prior to registration
• •Residual disease following resection of recurrent glioblastoma is not mandated for eligibility into the study; to best assess the extent of residual disease post-operatively, a post-operative or intra-operative MRI scan (or CT scan for patients with non-compatible devices) must be performed prior to registration and should be within 96 hours post surgery (although 24 hours would be optimum)
• •History/physical examination, including neurologic examination, within 14 days prior to registration
• •Karnofsky performance status \>= 60 within 14 days prior to registration
• •Complete blood count (CBC)/differential obtained within 14 days prior to registration, with adequate bone marrow function
• •Absolute neutrophil count (ANC) \>= 1,500 cells/mm\^3
• •Platelets \>= 75,000 cells/mm\^3
• •Hemoglobin \>= 9.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin (Hgb) \>= 9.0 g/dl is acceptable)
• •Total bilirubin =\< 2.0 mg/dL
• •Serum glutamic oxaloacetic transaminase (SGOT) or aspartate aminotransferase (AST) =\< 2.5 times the upper limit of normal
• •Serum creatinine =\< 1.8 mg/dL
• •Urine protein creatinine (UPC) ratio \>= 1.0 within 14 days prior to registration OR urine dipstick for proteinuria \>= 2+ (patients discovered to have \>= 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24-hour urine collection and must demonstrate =\< 1g of protein in 24 hours to be eligible)
• •* Note: UPC ratio of spot urine is an estimation of the 24-hour urine protein excretion; a UPC ratio of 1 is roughly equivalent to a 24-hour urine protein of 1 gm; UPC ratio is calculated using one of the following formulas:
• •* \[urine protein\]/\[urine creatinine\]: if both protein and creatinine are reported in mg/dL
• •* \[(urine protein) x 0.088\]/\[urine creatinine\]: if urine creatinine is reported in mmol/L
• •Patients must not be pregnant (positive pregnancy test) or breast feeding; pregnancy test must be done within 14 days prior to registration; effective contraception (men and women) must be used in patients of child-bearing potential while on trial and for 6 months after
• •Patients on full-dose anticoagulants (e.g., warfarin or low molecular weight (LMW) heparin) must meet both of the following criteria:
• •* No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)
• •* In-range international normalized ratio (INR) (usually between 2 and 3) on a stable dose of oral anticoagulant or on a stable dose of low molecular weight heparin, within 14 days prior to registration
• •Patient must be able to provide study-specific informed consent prior to study entry