Li Yi, Ali Saad, Clarke Jennifer, Cha Soonmee
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Department of Radiology, University of Chicago, Chicago, IL, USA.
Brain Tumor Res Treat. 2017 Apr;5(1):1-9. doi: 10.14791/btrt.2017.5.1.1. Epub 2017 Apr 30.
Glioblastoma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, has increasingly been used in the treatment of recurrent glioblastoma. It has achieved excellent rates of radiographic response, but most patients will progress after only a few months. Upon recurrence, tumors may not enhance, secondary to vascular normalization. We describe four patterns of radiographic progression commonly associated with Bevacizumab failure: 1) Distant enhancing tumor, 2) Local tumor progression without enhancement, 3) Diffuse gliomatosis-like infiltration, and 4) Local or multifocal progression, with enhancement. Some have noted an increased incidence of distant or diffuse disease upon recurrence, suggestive of a transition to a more aggressive phenotype, but a review of the literature suggests there is no conclusive evidence that Bevacizumab treatment is associated with an increased rate of distant or diffuse recurrence.
胶质母细胞瘤是成人中最常见的原发性恶性脑肿瘤，具有高度侵袭性且预后较差。贝伐单抗是一种抗血管内皮生长因子受体的单克隆抗体，越来越多地用于复发性胶质母细胞瘤的治疗。它已取得了优异的影像学反应率，但大多数患者在仅几个月后就会进展。复发时，肿瘤可能不会强化，这是血管正常化的继发结果。我们描述了四种通常与贝伐单抗治疗失败相关的影像学进展模式：1）远处强化肿瘤，2）无强化的局部肿瘤进展，3）弥漫性胶质瘤样浸润，4）有强化的局部或多灶性进展。一些人注意到复发时远处或弥漫性疾病的发生率增加，提示向更具侵袭性的表型转变，但文献综述表明，没有确凿证据表明贝伐单抗治疗与远处或弥漫性复发率增加有关。
