apparent diffusion coefficient in recurrent glioblastoma treated with bevacizumab oscar s. chirife,...
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Apparent Diffusion Coefficient in recurrent Glioblastoma treated with Bevacizumab
Oscar S. Chirife , Teresa Pujol, Joan Berenguer, Javier Moreno, Izaskun Valduvieco, Eugenia Verger, Laura
Oleaga.
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BACKGROUND
• Glioblastomas (GB) are the most aggressive and lethal primary brain tumors.
• Treatment with bevacizumab (BV) for recurrent GB in patients treated with standard radiotherapy (RT) and temozolamide (TMZ) has demonstrated in different studies a significant overall survival.
• The Apparent Diffusion Coefficient (ADC) as a imaging biomarker has been correlated with prognosis in newly diagnosed gliomas.
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•To evaluate ADC values in patients with recurrent GB treated with BV.
•To correlate ADC with clinical and radiological response, progression-free (PFS) and overall survival (OS).
PURPOSE
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MATERIAL AND METHODS
PATIENTS•Ten consecutive adult patients with proven recurrent or progressive GB after RT/ TMZ therapy determined by the RANO criteria and treated with BV, were enrolled.
•Clinical status was assessed using the Karnofsky Performance Scale (KPS).
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IMAGING PROTOCOL
Sagittal 3D T1W
Diffusion Tensor imaging (30 directions)
Axial T1W SE
Axial FLAIR
SWI
Sagittal 3D T2W TSE
First-pass echo-planar dynamic susceptibility-weighted contrast-enhanced (DSC)
Sagittal 3D T1-weighted +Gad
Axial T1W SE post Gad
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MR ASSESSMENT
• Both pre and first post BV MR were analyzed.
• The evaluation was performed by two experienced neuroradiologists active members of the multidisciplinary brain tumor board (LO y TP).
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STATISTICAL ANALYSIS
• The correlation of the ADC value with the response to BV was evaluated using the Fisher’s exact test
• PFS and OS were correlated with the ADC values using Kaplan-Meier and log-rank test
• Statistical analyses were performed using the statistical package SPSS 17
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RESULTS
Mean (range)
Age 59 (40-74)
KPS 80 (50-100)
FPS (months) 6 (1-11)
OS (months) 8 (1-13)
mADC CONTRAST ENHANCEMENT PRE BV
1297 (1025-1483)
lowADC CONTRAST ENHANCEMENT PRE BV
828 (568-1050)
mADC FLAIR ABNORMALITY PRE BV
1387 (1068-1631)
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ADC VALUES AND PROGRESSION
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CONCLUSIONS
Patients with high ADC values (mADC>1300 10-6mm2/s and lowADC>800 10-6mm2/s) in the pretreatment study show a higher OS, and can be useful to predict survival in patients with recurrent GB treated with bevacizumab.
This is a preliminary study (working progress) and more patients should be included to confirm results.
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REFERENCES• Murakami R, Sugahara T, Nakamura H et al (2007) Malignant supratentorial astrocytoma treated with postoperative
radiation therapy: prognostic value of pretreatment quantitative diffusion weighted MR imaging. Radiology 243:493–499
• Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996
• Norden AD, Drappatz J, Wen PY (2009) Antiangiogenic therapies for high-grade glioma. Nat Rev Neurol 5:610–620
• Macdonald DR, Cascino TL, Schold SC Jr et al (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280
• Nagane M, Kobayashi K, Tanaka et al (2013) Predictive significance of mean apparent diffusion coefficient value for responsiveness of temozolomide-refractory malignant glioma to bevacizumab: preliminary report. Int J Clin Oncol. DOI 10.1007/s10147-013-0517-x
• Pope WB, Lai A, Mehta R et al (2011) Apparent diffusion coefficient histogram analysis stratifies progression-free survival in newly diagnosed bevacizumab-treated glioblastoma. AJNR Am J Neuroradiol 32:882–889
• Pope WB, Kim HJ, Huo J et al (2009) Recurrent glioblastoma multiforme: ADC histogram analysis predicts response to bevacizumab treatment. Radiology 252:182–189-
• Grupo Neurooncología de la Sociedad Española de Nauroradiología (2011). Criterios de respuesta de los tumores cerebrales. Disponible en: http://www.senr.org/pdf/section_4/Criterios_respuesta_Neuroon2011.pdf