Oliver Bähr1, Patrick N Harter2, Lutz M Weise2, Se-Jong You2, Michel Mittelbronn2, Michael W Ronellenfitsch2, Johannes Rieger2, Joachim P Steinbach2, Elke Hattingen2. 1. From the Dr. Senckenberg Institute of Neurooncology (O.B., M.W.R., J.R., J.P.S.), Institute of Neurology (Edinger-Institute) (P.N.H., M.M.), Department of Neurosurgery (L.M.W.), and Institute of Neuroradiology (S.-J.Y., E.H.), University Hospital Frankfurt, Goethe University, Frankfurt; and German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) (O.B., P.N.H., L.M.W., S.-J.Y., M.M., M.W.R., J.R., J.P.S., E.H.), Heidelberg, Germany. oliver.baehr@med.uni-frankfurt.de. 2. From the Dr. Senckenberg Institute of Neurooncology (O.B., M.W.R., J.R., J.P.S.), Institute of Neurology (Edinger-Institute) (P.N.H., M.M.), Department of Neurosurgery (L.M.W.), and Institute of Neuroradiology (S.-J.Y., E.H.), University Hospital Frankfurt, Goethe University, Frankfurt; and German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) (O.B., P.N.H., L.M.W., S.-J.Y., M.M., M.W.R., J.R., J.P.S., E.H.), Heidelberg, Germany.
Abstract
OBJECTIVES: To investigate the relevance of bevacizumab (BEV)-induced diffusion-restricted lesions and T1-hyperintense lesions in patients with recurrent glioblastoma. METHODS: We prospectively screened 74 BEV-treated patients with recurrent glioblastoma for (1) diffusion-restricted lesions and/or, (2) lesions with a hyperintense signal on precontrast T1-weighted images. We further evaluated overall survival (OS), histopathology of the lesions, and patterns of progression. RESULTS: Twenty-five of 74 patients (34%) developed T1-hyperintense lesions, whereas diffusion-restricted lesions could be detected in 35 of 74 patients (47%). In 21 of 74 patients (28%), the lesions displayed both features ("double-positive"). OS for patients with double-positive lesions was 13.0 months; patients with neither of these lesions had an OS of 6.6 months (p < 0.005). Histologic evaluation of double-positive lesions revealed extensive calcified necrosis in 4 of 4 patients. Notably, these double-positive lesions were rarely involved in further tumor progression. However, they were associated with an increase in distant recurrences at BEV failure. CONCLUSIONS: BEV-induced double-positive MRI lesions are a predictive imaging marker associated with a substantial survival benefit and with improved local control in patients with recurrent glioblastoma. Our data suggest that these lesions are the result of a sustained focal antitumor activity of BEV.
OBJECTIVES: To investigate the relevance of bevacizumab (BEV)-induced diffusion-restricted lesions and T1-hyperintense lesions in patients with recurrent glioblastoma. METHODS: We prospectively screened 74 BEV-treated patients with recurrent glioblastoma for (1) diffusion-restricted lesions and/or, (2) lesions with a hyperintense signal on precontrast T1-weighted images. We further evaluated overall survival (OS), histopathology of the lesions, and patterns of progression. RESULTS: Twenty-five of 74 patients (34%) developed T1-hyperintense lesions, whereas diffusion-restricted lesions could be detected in 35 of 74 patients (47%). In 21 of 74 patients (28%), the lesions displayed both features ("double-positive"). OS for patients with double-positive lesions was 13.0 months; patients with neither of these lesions had an OS of 6.6 months (p < 0.005). Histologic evaluation of double-positive lesions revealed extensive calcified necrosis in 4 of 4 patients. Notably, these double-positive lesions were rarely involved in further tumor progression. However, they were associated with an increase in distant recurrences at BEV failure. CONCLUSIONS:BEV-induced double-positive MRI lesions are a predictive imaging marker associated with a substantial survival benefit and with improved local control in patients with recurrent glioblastoma. Our data suggest that these lesions are the result of a sustained focal antitumor activity of BEV.
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