From the Dr. Senckenberg Institute of Neurooncology (O.B., M.W.R., J.R., J.P.S.), Institute of Neurology (Edinger-Institute) (P.N.H., M.M.), Department of Neurosurgery (L.M.W.), and Institute of Neuroradiology (S.-J.Y., E.H.), University Hospital Frankfurt, Goethe University, Frankfurt; and German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) (O.B., P.N.H., L.M.W., S.-J.Y., M.M., M.W.R., J.R., J.P.S., E.H.), Heidelberg, Germany.
Neurology. 2014 Jul 15;83(3):227-34. doi: 10.1212/WNL.0000000000000594. Epub 2014 Jun 13.
To investigate the relevance of bevacizumab (BEV)-induced diffusion-restricted lesions and T1-hyperintense lesions in patients with recurrent glioblastoma.
We prospectively screened 74 BEV-treated patients with recurrent glioblastoma for (1) diffusion-restricted lesions and/or, (2) lesions with a hyperintense signal on precontrast T1-weighted images. We further evaluated overall survival (OS), histopathology of the lesions, and patterns of progression.
Twenty-five of 74 patients (34%) developed T1-hyperintense lesions, whereas diffusion-restricted lesions could be detected in 35 of 74 patients (47%). In 21 of 74 patients (28%), the lesions displayed both features ("double-positive"). OS for patients with double-positive lesions was 13.0 months; patients with neither of these lesions had an OS of 6.6 months (p < 0.005). Histologic evaluation of double-positive lesions revealed extensive calcified necrosis in 4 of 4 patients. Notably, these double-positive lesions were rarely involved in further tumor progression. However, they were associated with an increase in distant recurrences at BEV failure.
BEV-induced double-positive MRI lesions are a predictive imaging marker associated with a substantial survival benefit and with improved local control in patients with recurrent glioblastoma. Our data suggest that these lesions are the result of a sustained focal antitumor activity of BEV.
探讨贝伐单抗（BEV）诱导的扩散受限病变和 T1 高信号病变与复发性胶质母细胞瘤患者的相关性。
我们前瞻性筛选了 74 例接受 BEV 治疗的复发性胶质母细胞瘤患者，以寻找（1）扩散受限病变和/或，（2）对比增强 T1 加权图像上呈高信号的病变。我们进一步评估了总生存期（OS）、病变的组织病理学和进展模式。
74 例患者中有 25 例（34%）出现 T1 高信号病变，而 74 例中有 35 例（47%）可检测到扩散受限病变。在 74 例患者中，有 21 例（28%）的病变同时具有这两种特征（“双阳性”）。双阳性病变患者的 OS 为 13.0 个月；而无这两种病变的患者的 OS 为 6.6 个月（p < 0.005）。对双阳性病变的组织学评估显示，4 例患者均存在广泛的钙化性坏死。值得注意的是，这些双阳性病变很少涉及进一步的肿瘤进展。然而，它们与 BEV 失败时远处复发的增加有关。
BEV 诱导的双阳性 MRI 病变是一种预测性的影像学标志物，与复发性胶质母细胞瘤患者的生存获益显著相关，并可改善局部控制。我们的数据表明，这些病变是 BEV 持续的局部抗肿瘤活性的结果。
