Kickingereder Philipp, Wiestler Benedikt, Burth Sina, Wick Antje, Nowosielski Martha, Heiland Sabine, Schlemmer Heinz-Peter, Wick Wolfgang, Bendszus Martin, Radbruch Alexander
Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany (P.K., S.B., S.H., M.B., A.R.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ, Heidelberg, Germany (B.W., W.W.); Department of Neurology, Medical University Innsbruck, Innsbruck, Austria (M.N.); Department of Radiology, DKFZ, Heidelberg, Germany (H.-P.S., A.R.).
Neuro Oncol. 2015 Aug;17(8):1139-47. doi: 10.1093/neuonc/nov028. Epub 2015 Mar 9.
To analyze the relevance of dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) derived relative cerebral blood volume (rCBV) analysis for predicting response to bevacizumab (BEV) in patients with recurrent glioblastoma (rGB).
A total of 127 patients diagnosed with rGB receiving either bevacizumab (71 patients, BEV cohort) or alkylating chemotherapy (56 patients, non-BEV cohort) underwent conventional anatomic MRI and DSC-MRI at baseline and at first follow-up after treatment initiation. The mean rCBV of the contrast-enhancing tumor (cT1) as well as cT1 and fluid-attenuated inversion recovery (FLAIR) volumes at both time points were correlated with progression-free survival (PFS) and overall survival (OS) using Cox proportional hazard models, logistic regression, and the log-rank test.
Baseline rCBV was associated with both PFS (hazard ratio [HR] = 1.3; P < .01) and OS (HR = 1.3; P < .01) in the BEV cohort and predicted 6-month PFS in 82% and 12-month OS in 79% of patients, whereas it was not associated with PFS (HR = 1.0; P = .70) or OS (HR = 1.0; P = .47) in the non-BEV cohort. Corresponding median OS and PFS rates in the BEV cohort for patients with rCBV-values less than 3.92 (optimal threshold from receiver operating characteristic [ROC] analysis of 12-month OS data) were 14.2 and 6.0 months, as compared to 6.6 and 2.8 months for patients with rCBV-values greater than 3.92 (P < .01, respectively). cT1 and FLAIR volumes at first follow-up were significant predictors of 6-month PFS and 12-month OS in the BEV cohort but not in the non-BEV cohort. Corresponding volumes at baseline were not significant in any cohort.
Pretreatment rCBV is a potential predictive imaging biomarker in BEV-treated rGB but not alkylating chemotherapy-treated rGB, which is superior to volumetric analysis of conventional anatomic MRI and predicts 6-month PFS and 12-month OS in 80% of BEV-treated patients.
分析动态磁敏感加权对比增强磁共振成像（DSC-MRI）衍生的相对脑血容量（rCBV）分析在预测复发性胶质母细胞瘤（rGB）患者对贝伐单抗（BEV）反应中的相关性。
共有127例诊断为rGB的患者，其中71例接受贝伐单抗治疗（BEV队列），56例接受烷化剂化疗（非BEV队列），在基线期及治疗开始后的首次随访时接受了传统解剖MRI和DSC-MRI检查。使用Cox比例风险模型、逻辑回归和对数秩检验，将两个时间点的强化肿瘤（cT1）的平均rCBV以及cT1和液体衰减反转恢复（FLAIR）体积与无进展生存期（PFS）和总生存期（OS）进行相关性分析。
在BEV队列中，基线rCBV与PFS（风险比[HR]=1.3；P<.01）和OS（HR=1.3；P<.01）均相关，可预测82%的患者6个月PFS和79%的患者12个月OS，而在非BEV队列中，其与PFS（HR=1.0；P=.70）或OS（HR=1.0；P=.47）均无关。rCBV值小于3.92（来自12个月OS数据的受试者操作特征[ROC]分析的最佳阈值）的BEV队列患者的相应中位OS和PFS率分别为14.2和6.0个月，而rCBV值大于3.92的患者分别为6.6和2.8个月（P均<.01）。首次随访时的cT1和FLAIR体积是BEV队列中6个月PFS和12个月OS的显著预测指标，但在非BEV队列中不是。任何队列中基线时的相应体积均无显著性差异。
治疗前rCBV是接受BEV治疗的rGB患者潜在的预测性影像生物标志物，但不是接受烷化剂化疗的rGB患者的预测性影像生物标志物，其优于传统解剖MRI的体积分析，可预测80%接受BEV治疗患者的6个月PFS和12个月OS。
