BACKGROUND: 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. OBJECTIVE: To determine if diffusion MR characteristics can predict survival outcomes in patients with large volume recurrent glioblastoma treated with bevacizumab or repeat resection. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVE: To determine if diffusion MR characteristics can predict survival outcomes in patients with large volume recurrent glioblastoma treated with bevacizumab or repeat resection. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Authors: Benjamin M Ellingson; Martin Bendszus; Jerrold Boxerman; Daniel Barboriak; Bradley J Erickson; Marion Smits; Sarah J Nelson; Elizabeth Gerstner; Brian Alexander; Gregory Goldmacher; Wolfgang Wick; Michael Vogelbaum; Michael Weller; Evanthia Galanis; Jayashree Kalpathy-Cramer; Lalitha Shankar; Paula Jacobs; Whitney B Pope; Dewen Yang; Caroline Chung; Michael V Knopp; Soonme Cha; Martin J van den Bent; Susan Chang; W K Al Yung; Timothy F Cloughesy; Patrick Y Wen; Mark R Gilbert Journal: Neuro Oncol Date: 2015-08-05 Impact factor: 12.300
Authors: Benjamin M Ellingson; Robert J Harris; Davis C Woodworth; Kevin Leu; Okkar Zaw; Warren P Mason; Solmaz Sahebjam; Lauren E Abrey; Dana T Aftab; Gisela M Schwab; Colin Hessel; Albert Lai; Phioanh L Nghiemphu; Whitney B Pope; Patrick Y Wen; Timothy F Cloughesy Journal: Neuro Oncol Date: 2016-08-31 Impact factor: 12.300
Authors: Benjamin M Ellingson; Mark G Malkin; Scott D Rand; Jennifer M Connelly; Carolyn Quinsey; Pete S LaViolette; Devyani P Bedekar; Kathleen M Schmainda Journal: J Magn Reson Imaging Date: 2010-03 Impact factor: 4.813
Authors: Davis C Woodworth; Whitney B Pope; Linda M Liau; Hyun J Kim; Albert Lai; Phioanh L Nghiemphu; Timothy F Cloughesy; Benjamin M Ellingson Journal: J Neurooncol Date: 2013-12-07 Impact factor: 4.130
Authors: Benjamin M Ellingson; Elizabeth R Gerstner; Marion Smits; Raymond Y Huang; Rivka Colen; Lauren E Abrey; Dana T Aftab; Gisela M Schwab; Colin Hessel; Robert J Harris; Ararat Chakhoyan; Renske Gahrmann; Whitney B Pope; Kevin Leu; Catalina Raymond; Davis C Woodworth; John de Groot; Patrick Y Wen; Tracy T Batchelor; Martin J van den Bent; Timothy F Cloughesy Journal: Clin Cancer Res Date: 2017-06-27 Impact factor: 12.531
Authors: Timothy Cloughesy; Gaetano Finocchiaro; Cristóbal Belda-Iniesta; Lawrence Recht; Alba A Brandes; Estela Pineda; Tom Mikkelsen; Olivier L Chinot; Carmen Balana; David R Macdonald; Manfred Westphal; Kirsten Hopkins; Michael Weller; Carlos Bais; Thomas Sandmann; Jean-Marie Bruey; Hartmut Koeppen; Bo Liu; Wendy Verret; See-Chun Phan; David S Shames Journal: J Clin Oncol Date: 2016-12-05 Impact factor: 44.544
Authors: Teri N Kreisl; Lyndon Kim; Kraig Moore; Paul Duic; Cheryl Royce; Irene Stroud; Nancy Garren; Megan Mackey; John A Butman; Kevin Camphausen; John Park; Paul S Albert; Howard A Fine Journal: J Clin Oncol Date: 2008-12-29 Impact factor: 44.544
Authors: Henry S Friedman; Michael D Prados; Patrick Y Wen; Tom Mikkelsen; David Schiff; Lauren E Abrey; W K Alfred Yung; Nina Paleologos; Martin K Nicholas; Randy Jensen; James Vredenburgh; Jane Huang; Maoxia Zheng; Timothy Cloughesy Journal: J Clin Oncol Date: 2009-08-31 Impact factor: 44.544
Authors: Rik van den Elshout; Tom W J Scheenen; Chantal M L Driessen; Robert J Smeenk; Frederick J A Meijer; Dylan Henssen Journal: Insights Imaging Date: 2022-10-04
Authors: Akifumi Hagiwara; Talia C Oughourlian; Nicholas S Cho; Jacob Schlossman; Chencai Wang; Jingwen Yao; Catalina Raymond; Richard Everson; Kunal Patel; Sergey Mareninov; Fausto J Rodriguez; Noriko Salamon; Whitney B Pope; Phioanh L Nghiemphu; Linda M Liau; Robert M Prins; Timothy F Cloughesy; Benjamin M Ellingson Journal: Neuro Oncol Date: 2022-06-01 Impact factor: 13.029
Authors: R Kurokawa; A Baba; M Kurokawa; A Capizzano; O Hassan; T Johnson; Y Ota; J Kim; A Hagiwara; T Moritani; A Srinivasan Journal: AJNR Am J Neuroradiol Date: 2022-01-20 Impact factor: 3.825
Authors: Benjamin M Ellingson; Kunal Patel; Chencai Wang; Catalina Raymond; Andrew Brenner; John F de Groot; Nicholas A Butowski; Leor Zach; Jian L Campian; Jacob Schlossman; Shan Rizvi; Yael C Cohen; Noa Lowenton-Spier; Tamar Rachmilewitz Minei; Shifra Fain Shmueli; Patrick Y Wen; Timothy F Cloughesy Journal: Neurooncol Adv Date: 2021-06-19