Apparent Diffusion Coefficient in recurrent Glioblastoma treated with Bevacizumab Oscar S. Chirife,...
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Transcript of Apparent Diffusion Coefficient in recurrent Glioblastoma treated with Bevacizumab Oscar S. Chirife,...
Apparent Diffusion Coefficient in recurrent Glioblastoma treated with Bevacizumab
Oscar S. Chirife , Teresa Pujol, Joan Berenguer, Javier Moreno, Izaskun Valduvieco, Eugenia Verger, Laura
Oleaga.
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.
•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
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).
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
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).
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
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)
ADC VALUES AND PROGRESSION
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.
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