Department of Radiologic Sciences, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, CHS, BL-428, Los Angeles, CA 90095-1721, USA.
Neurology. 2011 Feb 1;76(5):432-7. doi: 10.1212/WNL.0b013e31820a0a8a.
We evaluated patterns of tumor progression in patients with recurrent glioblastoma who were treated with bevacizumab (BEV) alone or in combination with irinotecan (CPT-11) while participating in the BRAIN study.
An independent neuroradiologist reviewed MRI scans at baseline and progression in patients who received BEV (n = 85) or BEV+CPT-11 (n = 82) while on BRAIN. Tumor patterns were scored as local, distant, diffuse, or multifocal. Median progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Hazard ratios for PFS and OS were estimated using a Cox regression model.
Twenty-eight percent of patients who participated in BRAIN had nonlocal disease at baseline (72% local disease). Sixty-seven (79%) patients treated with single-agent BEV and 57 (70%) patients treated with BEV+CPT-11 experienced disease progression while on BRAIN. Most patients in each treatment group did not have a change in the radiographic pattern of their tumor (i.e., "no shift") at the time of progression. The proportion of BEV patients with no shift (82%) was greater than that of BEV+CPT-11 patients (53%, χ(2) p = 0.0004), and a greater proportion of BEV+CPT-11 patients (39%) compared with BEV patients (16%) experienced local-to-diffuse tumor pattern at progression (χ(2) p = 0.002). Patients treated with BEV or BEV+CPT-11 who had local-to-local or local-to-diffuse progression patterns had similar efficacy outcomes, including objective response, PFS, and OS.
Most patients treated with BEV or BEV+CPT-11 on BRAIN did not experience a change from baseline in radiographic characteristics of disease at the time of progression.
我们评估了接受贝伐单抗（BEV）单药或联合伊立替康（CPT-11）治疗的复发性胶质母细胞瘤患者的肿瘤进展模式，这些患者参与了 BRAIN 研究。
一名独立的神经放射科医生对接受 BEV（n=85）或 BEV+CPT-11（n=82）治疗的 BRAIN 患者的基线和进展时的 MRI 扫描进行了回顾。肿瘤模式被评为局部、远处、弥漫或多灶性。使用 Kaplan-Meier 方法估计无进展生存期（PFS）和总生存期（OS）。使用 Cox 回归模型估计 PFS 和 OS 的风险比。
参与 BRAIN 的患者中有 28%在基线时患有非局部疾病（72%为局部疾病）。67 名接受单药 BEV 治疗的患者（79%）和 57 名接受 BEV+CPT-11 治疗的患者（70%）在接受 BRAIN 治疗时出现疾病进展。在每个治疗组中，大多数患者在进展时肿瘤的影像学模式没有改变（即“无转移”）。无转移的 BEV 患者比例（82%）大于 BEV+CPT-11 患者（53%，χ(2) p=0.0004），并且与 BEV 患者（16%）相比，BEV+CPT-11 患者（39%）中更多的患者在进展时出现局部至弥漫性肿瘤模式（χ(2) p=0.002）。接受 BEV 或 BEV+CPT-11 治疗的患者，局部至局部或局部至弥漫性进展模式具有相似的疗效结果，包括客观缓解、PFS 和 OS。
在 BRAIN 中接受 BEV 或 BEV+CPT-11 治疗的大多数患者在进展时，疾病的影像学特征没有从基线改变。
