Low-dose Bevacizumab With HSRT vs BVZ Alone for GBM at First Recurrence

Inclusion Criteria:

* 18-70 years of age;
* Karnofsky performance status (KPS) ≥ 60;
* Original histopathologically proven diagnosis World Health Organization (WHO) Grade 3/4 glioma;
* Underwent surgery, chemoradiotherapy and adjuvant chemotherapy (Stupp Protocol) after initial diagnosis, recurrent based on the Response Assessment in Neuro-Oncology (RANO) criteria and/or histopathologically proven;
* Measurable disease;
* Estimated survival of at least 3 months, maximal diameter on T1+C MRI ≤ 3.5 cm;
* Hgb \> 9 gm; absolute neutrophil count (ANC) \> 1500/μl; platelets \> 100,000; Creatinine \< 1.5 times the upper limit of laboratory normal value; Bilirubin \< 2 times the upper limit of laboratory normal value; serum glutamate pyruvate transaminase (SGPT) or serum glutamate oxaloacetate transaminase (SGOT) \< 3 times the upper limit of laboratory normal value;
* Signed informed consent form;
* Agreed to participate the follow-up.

Exclusion Criteria:

* Prior invasive malignancy unless disease free;
* Received re-irradiation;
* More than 3 relapses or evidence of subtentorial recurrent disease or tumor greater than 6 cm in maximum diameter;
* Prior therapy with an inhibitor of vascular endothelial growth factor (VEGF) or VEGFR;
* Pregnancy or or nursing mothers;
* Participated in other trials after diagnosis of recurrent;
* Influence factors toward oral medications;
* Patients with CTCAE5.0 grade 3+ bleeding;
* Suffering from severe cardiovascular disease: myocardial ischemia or myocardial infarction above grade II, poorly controlled arrhythmias (including men with QTc interval ≥ 450 ms, women ≥ 470 ms); according to NYHA criteria, grades III to IV Insufficient function, or cardiac color Doppler ultrasound examination indicates left ventricular ejection fraction (LVEF) \<50%;
* Long-term unhealed wounds or fractures;
* History of organ transplantation;
* Serious diseases that endanger patients' safety or affect patients' completion of research,according to the researchers' judgment.