Kathleen M Schmainda1, Melissa Prah1, Jennifer Connelly1, Scott D Rand1, Raymond G Hoffman1, Wade Mueller1, Mark G Malkin1. 1. Department of Radiology, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S., M.P., S.D.R.); Department of Biophysics, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S.); Translational Brain Tumor Research Program, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S., J.C., S.D.R., W.M., M.G.M.); Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin (J.C., M.G.M.); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (R.G.H); Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin (J.C., W.M., M.G.M.).
Abstract
BACKGROUND: The anti-VEGF antibody, bevacizumab, is standard treatment for patients with recurrent glioblastoma. In this setting, traditional anatomic MRI methods such as post-contrast T1-weighted and T2-weighted imaging are proving unreliable for monitoring response. Here we evaluate the prognostic significance of pre- and posttreatment relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast MRI to predict response to bevacizumab. METHODS: Thirty-six participants with recurrent high-grade gliomas who underwent rCBV imaging 60 days before and 20-60 days after starting bevacizumab treatment were enrolled. Tumor regions of interest (ROIs) were determined from deltaT1 maps computed from the difference between standardized post and precontrast T1-weighted images. Both pre- and posttreatment rCBV maps were corrected for leakage and standardized (stdRCBV) to a consistent intensity scale. The Kaplan-Meier method was used to determine if either the pre- or post-bevacizumab stdRCBV within the tumor ROI was predictive of overall survival (OS) or progression free survival (PFS). RESULTS: The OS was significantly longer if either the pre- (380d vs 175d; P=.0024) or posttreatment stdRCBV (340d vs 186d; P = .0065) was <4400. The posttreatment stdRCBV was also predictive of PFS (167d vs 78d; P = .0006). When the stdRCBV values were both above versus both below threshold, the OS was significantly worse (100.5d vs 395d; P < .0001). With a 32.5% decrease in stdRCBV, the risk of death was reduced by about 68% but increased by 140% with a 29% increase in stdRCBV. CONCLUSIONS: Standardized rCBV is predictive of OS and PFS in patients with recurrent high-grade brain tumor treated with bevacizumab.
BACKGROUND: The anti-VEGF antibody, bevacizumab, is standard treatment for patients with recurrent glioblastoma. In this setting, traditional anatomic MRI methods such as post-contrast T1-weighted and T2-weighted imaging are proving unreliable for monitoring response. Here we evaluate the prognostic significance of pre- and posttreatment relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast MRI to predict response to bevacizumab. METHODS: Thirty-six participants with recurrent high-grade gliomas who underwent rCBV imaging 60 days before and 20-60 days after starting bevacizumab treatment were enrolled. Tumor regions of interest (ROIs) were determined from deltaT1 maps computed from the difference between standardized post and precontrast T1-weighted images. Both pre- and posttreatment rCBV maps were corrected for leakage and standardized (stdRCBV) to a consistent intensity scale. The Kaplan-Meier method was used to determine if either the pre- or post-bevacizumabstdRCBV within the tumor ROI was predictive of overall survival (OS) or progression free survival (PFS). RESULTS: The OS was significantly longer if either the pre- (380d vs 175d; P=.0024) or posttreatment stdRCBV (340d vs 186d; P = .0065) was <4400. The posttreatment stdRCBV was also predictive of PFS (167d vs 78d; P = .0006). When the stdRCBV values were both above versus both below threshold, the OS was significantly worse (100.5d vs 395d; P < .0001). With a 32.5% decrease in stdRCBV, the risk of death was reduced by about 68% but increased by 140% with a 29% increase in stdRCBV. CONCLUSIONS: Standardized rCBV is predictive of OS and PFS in patients with recurrent high-grade brain tumor treated with bevacizumab.
Authors: Meng Law; Sarah Oh; James S Babb; Edwin Wang; Matilde Inglese; David Zagzag; Edmond A Knopp; Glyn Johnson Journal: Radiology Date: 2006-01-05 Impact factor: 11.105
Authors: Tracy T Batchelor; A Gregory Sorensen; Emmanuelle di Tomaso; Wei-Ting Zhang; Dan G Duda; Kenneth S Cohen; Kevin R Kozak; Daniel P Cahill; Poe-Jou Chen; Mingwang Zhu; Marek Ancukiewicz; Maciej M Mrugala; Scott Plotkin; Jan Drappatz; David N Louis; Percy Ivy; David T Scadden; Thomas Benner; Jay S Loeffler; Patrick Y Wen; Rakesh K Jain Journal: Cancer Cell Date: 2007-01 Impact factor: 31.743
Authors: L S Hu; L C Baxter; K A Smith; B G Feuerstein; J P Karis; J M Eschbacher; S W Coons; P Nakaji; R F Yeh; J Debbins; J E Heiserman Journal: AJNR Am J Neuroradiol Date: 2008-12-04 Impact factor: 3.825
Authors: R M Zuniga; R Torcuator; R Jain; J Anderson; T Doyle; S Ellika; L Schultz; T Mikkelsen Journal: J Neurooncol Date: 2008-10-25 Impact factor: 4.130
Authors: H J Aronen; I E Gazit; D N Louis; B R Buchbinder; F S Pardo; R M Weisskoff; G R Harsh; G R Cosgrove; E F Halpern; F H Hochberg Journal: Radiology Date: 1994-04 Impact factor: 11.105
Authors: D Daniels; D Guez; D Last; C Hoffmann; D Nass; A Talianski; G Tsarfaty; S Salomon; A A Kanner; D T Blumenthal; F Bokstein; S Harnof; D Yekutieli; S Zamir; Z R Cohen; L Zach; Y Mardor Journal: AJNR Am J Neuroradiol Date: 2016-07-07 Impact factor: 3.825
Authors: K M Schmainda; M A Prah; S D Rand; Y Liu; B Logan; M Muzi; S D Rane; X Da; Y-F Yen; J Kalpathy-Cramer; T L Chenevert; B Hoff; B Ross; Y Cao; M P Aryal; B Erickson; P Korfiatis; T Dondlinger; L Bell; L Hu; P E Kinahan; C C Quarles Journal: AJNR Am J Neuroradiol Date: 2018-05-24 Impact factor: 3.825
Authors: Sang Hyun Choi; Seung Chai Jung; Kyung Won Kim; Ja Youn Lee; Yoonseok Choi; Seong Ho Park; Ho Sung Kim Journal: J Neurooncol Date: 2016-04-23 Impact factor: 4.130
Authors: K M Schmainda; M A Prah; L S Hu; C C Quarles; N Semmineh; S D Rand; J M Connelly; B Anderies; Y Zhou; Y Liu; B Logan; A Stokes; G Baird; J L Boxerman Journal: AJNR Am J Neuroradiol Date: 2019-03-28 Impact factor: 3.825
Authors: Kathleen M Schmainda; Zheng Zhang; Melissa Prah; Bradley S Snyder; Mark R Gilbert; A Gregory Sorensen; Daniel P Barboriak; Jerrold L Boxerman Journal: Neuro Oncol Date: 2015-02-02 Impact factor: 12.300
Authors: Philip J O'Halloran; Thomas Viel; David W Murray; Lydia Wachsmuth; Katrin Schwegmann; Stefan Wagner; Klaus Kopka; Monika A Jarzabek; Patrick Dicker; Sven Hermann; Cornelius Faber; Tim Klasen; Michael Schäfers; David O'Brien; Jochen H M Prehn; Andreas H Jacobs; Annette T Byrne Journal: Eur J Nucl Med Mol Imaging Date: 2016-03-15 Impact factor: 9.236