title: FLAIR-only progression in bevacizumab-treated relapsing glioblastoma does not predict short survival.
abstract: OBJECTIVE
  In this study, we analyzed the prognostic value of different MRI progression patterns for survival in patients with recurrent malignant glioma treated with the vascular endothelial growth factor antibody bevacizumab.
  
  
  METHODS
  Twenty-six adult patients with recurrent malignant glioma treated with bevacizumab or bevacizumab/irinotecan were retrospectively analyzed for the development of contrast-enhanced (T1-weighted MRI) and T2/FLAIR lesions. According to the progression pattern, patients were divided into 3 subgroups: (1) patients with primarily progressive contrast-enhanced lesions in the first MRI after initiation of therapy ('primary PD group'); (2) patients with stable or regressive enhanced lesions but progressive FLAIR lesions ('FLAIR-only PD group'), and (3) patients with stable or regressive contrast-enhanced T1 and FLAIR lesions ('no PD group').
  
  
  RESULTS
  Overall survival (OS) in the 6 patients in the FLAIR-only PD group was not significantly different from the 11 patients in the no PD group (median 311 vs. 254 days, respectively). In contrast, survival in the FLAIR-only PD group was significantly better (p = 0.025) than in the primary PD group.
  
  
  CONCLUSIONS
  FLAIR-only progression is not an independent prognostic factor negatively influencing OS in recurrent glioblastoma treated with bevacizumab and should not lead to discontinuation of bevacizumab therapy.
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Schaub
authors.forename: Susanne
authors.initials: S
authors.lastname: Greschus
authors.forename: Mirko
authors.initials: M
authors.lastname: Seifert
authors.forename: Andreas
authors.initials: A
authors.lastname: Waha
authors.forename: Elias
authors.initials: E
authors.lastname: Blasius
authors.forename: Katja
authors.initials: K
authors.lastname: Rasch
authors.forename: Christiane
authors.initials: C
authors.lastname: Landwehr
authors.forename: Frederic
authors.initials: F
authors.lastname: Mack
authors.forename: Niklas
authors.initials: N
authors.lastname: Schäfer
authors.forename: Moritz
authors.initials: M
authors.lastname: Stuplich
authors.forename: Sied
authors.initials: S
authors.lastname: Kebir
authors.forename: Belinda
authors.initials: B
authors.lastname: Vilz
authors.forename: Björn
authors.initials: B
authors.lastname: Scheffler
authors.forename: Jan
authors.initials: J
authors.lastname: Boström
authors.forename: Matthias
authors.initials: M
authors.lastname: Simon
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Martin
authors.initials: M
authors.lastname: Glas
authors.forename: Ulrich
authors.initials: U
authors.lastname: Herrlinger
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D000077146:Irinotecan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin