UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Neurosurgery. 2020 Oct 15;87(5):931-938. doi: 10.1093/neuros/nyaa135.
Diffusion magnetic resonance (MR) characteristics are a predictive imaging biomarker for survival benefit in recurrent glioblastoma treated with anti-vascular endothelial growth factor (VEGF) therapy; however, its use in large volume recurrence has not been evaluated.
To determine if diffusion MR characteristics can predict survival outcomes in patients with large volume recurrent glioblastoma treated with bevacizumab or repeat resection.
A total of 32 patients with large volume (>20 cc or > 3.4 cm diameter) recurrent glioblastoma treated with bevacizumab and 35 patients treated with repeat surgery were included. Pretreatment tumor volume and apparent diffusion coefficient (ADC) histogram analysis were used to phenotype patients as having high (>1.24 μm2/ms) or low (<1.24 μm2/ms) ADCL, the mean value of the lower peak in a double Gaussian model of the ADC histogram within the contrast enhancing tumor.
In bevacizumab and surgical cohorts, volume was correlated with overall survival (Bevacizumab: P = .009, HR = 1.02; Surgical: P = .006, HR = 0.96). ADCL was an independent predictor of survival in the bevacizumab cohort (P = .049, HR = 0.44), but not the surgical cohort (P = .273, HR = 0.67). There was a survival advantage of surgery over bevacizumab in patients with low ADCL (P = .036, HR = 0.43) but not in patients with high ADCL (P = .284, HR = 0.69).
Pretreatment diffusion MR imaging is an independent predictive biomarker for overall survival in recurrent glioblastoma with a large tumor burden. Large tumors with low ADCL have a survival benefit when treated with surgical resection, whereas large tumors with high ADCL may be best managed with bevacizumab.
弥散磁共振（MR）特征是抗血管内皮生长因子（VEGF）治疗复发性胶质母细胞瘤生存获益的预测性成像生物标志物；然而，其在大体积复发中的应用尚未得到评估。
确定弥散 MR 特征是否可预测接受贝伐单抗或重复切除治疗的大体积复发性胶质母细胞瘤患者的生存结局。
共纳入 32 例接受贝伐单抗治疗和 35 例接受重复手术治疗的大体积（>20cc 或>3.4cm 直径）复发性胶质母细胞瘤患者。使用预处理肿瘤体积和表观弥散系数（ADC）直方图分析对患者进行表型分析，表现为 ADC 值较高（>1.24μm2/ms）或较低（<1.24μm2/ms），ADC 直方图双高斯模型中强化肿瘤内较低峰的平均值。
在贝伐单抗和手术队列中，体积与总生存期相关（贝伐单抗：P=0.009，HR=1.02；手术：P=0.006，HR=0.96）。在贝伐单抗队列中，ADC 值是生存的独立预测因子（P=0.049，HR=0.44），但在手术队列中不是（P=0.273，HR=0.67）。在 ADC 值较低的患者中，手术优于贝伐单抗（P=0.036，HR=0.43），而在 ADC 值较高的患者中则不然（P=0.284，HR=0.69）。
在大肿瘤负荷的复发性胶质母细胞瘤中，预处理弥散 MR 成像为总生存期的独立预测生物标志物。具有低 ADC 值的大肿瘤有接受手术切除的生存获益，而具有高 ADC 值的大肿瘤可能最好用贝伐单抗治疗。
