Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Neurosurgery, International University of Health and Welfare, Narita Hospital, Chiba, Japan.
J Neurooncol. 2021 Sep;154(2):187-196. doi: 10.1007/s11060-021-03812-9. Epub 2021 Jul 28.
Although we have shown the clinical benefit of bevacizumab (BEV) in the treatment of unresectable newly diagnosed glioblastomas (nd-GBM), the relationship between early radiographic response and survival outcome remains unclear. We performed a volumetric study of early radiographic responses in nd-GBM treated with BEV.
Twenty-two patients with unresectable nd-GBM treated with BEV during concurrent temozolomide radiotherapy were analyzed. An experienced neuroradiologist interpreted early responses on fluid-attenuated inversion recovery (FLAIR) and gadolinium-enhanced T1-weighted images (GdT1WI). Volumetric changes were evaluated using diffusion-weighted imaging (DWI) and GdT1WI according to the Response Assessment in Neuro-Oncology (RANO) criteria. The results were categorized into improved (complete response [CR] or partial response [PR]) or non-improved (stable disease [SD] or progressive disease [PD]) groups; outcomes were compared using Kaplan-Meier analysis.
The volumetric GdT1WI improvement was a significant predictive factor for overall survival (OS) prolongation (p = 0.0093, median OS: 24.7 vs. 13.6 months); however, FLAIR and DWI images were not predictive. The threshold for the neuroradiologist's interpretation of improvement in GdT1WI was nearly 20% of volume reduction, which was lesser than 50%, the definition of PR applied in the RANO criteria. However, even less stringent neuroradiologist interpretation could successfully predict OS prolongation (improved vs. non-improved: p = 0.0067, median OS: 17.6 vs. 8.3 months). Significant impact of OS on the early response in volumetric GdT1WI was observed within the cut-off range of 20-50% (20%, p = 0.0315; 30%, p = 0.087; 40%, p = 0.0456).
Early response during BEV-containing chemoradiation can be a predictive indicator of patient outcome in unresectable nd-GBM.
虽然我们已经证明贝伐单抗（BEV）在治疗不可切除的新诊断胶质母细胞瘤（nd-GBM）中的临床益处，但早期影像学反应与生存结果之间的关系仍不清楚。我们对接受 BEV 治疗的 nd-GBM 的早期影像学反应进行了容积研究。
对 22 例接受 BEV 联合替莫唑胺放疗的不可切除 nd-GBM 患者进行分析。一名有经验的神经放射科医生根据神经肿瘤学反应评估标准（RANO）在液体衰减反转恢复（FLAIR）和钆增强 T1 加权成像（GdT1WI）上解释早期反应。根据 RANO 标准，使用扩散加权成像（DWI）和 GdT1WI 评估容积变化。将结果分为改善（完全缓解[CR]或部分缓解[PR]）或未改善（稳定疾病[SD]或进展性疾病[PD]）组；使用 Kaplan-Meier 分析比较结果。
GdT1WI 容积改善是总生存期（OS）延长的显著预测因素（p=0.0093，中位 OS：24.7 与 13.6 个月）；然而，FLAIR 和 DWI 图像没有预测价值。神经放射科医生解释 GdT1WI 改善的阈值接近体积减少的 20%，小于 RANO 标准中 PR 的定义的 50%。然而，即使是不严格的神经放射科医生解释也可以成功预测 OS 延长（改善与未改善：p=0.0067，中位 OS：17.6 与 8.3 个月）。在 20%-50%的截止范围内观察到 OS 对 GdT1WI 早期反应的显著影响（20%，p=0.0315；30%，p=0.087；40%，p=0.0456）。
BEV 联合放化疗期间的早期反应可以成为不可切除 nd-GBM 患者预后的预测指标。
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