title: Dynamic susceptibility contrast MRI measures of relative cerebral blood volume as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 multicenter trial.
abstract: BACKGROUND
  The study goal was to determine whether changes in relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast (DSC) MRI are predictive of overall survival (OS) in patients with recurrent glioblastoma multiforme (GBM) when measured 2, 8, and 16 weeks after treatment initiation.
  
  
  METHODS
  Patients with recurrent GBM (37/123) enrolled in ACRIN 6677/RTOG 0625, a multicenter, randomized, phase II trial of bevacizumab with irinotecan or temozolomide, consented to DSC-MRI plus conventional MRI, 21 with DSC-MRI at baseline and at least 1 postbaseline scan. Contrast-enhancing regions of interest were determined semi-automatically using pre- and postcontrast T1-weighted images. Mean tumor rCBV normalized to white matter (nRCBV) and standardized rCBV (sRCBV) were determined for these regions of interest. The OS rates for patients with positive versus negative changes from baseline in nRCBV and sRCBV were compared using Wilcoxon rank-sum and Kaplan-Meier survival estimates with log-rank tests.
  
  
  RESULTS
  Patients surviving at least 1 year (OS-1) had significantly larger decreases in nRCBV at week 2 (P = .0451) and sRCBV at week 16 (P = .014). Receiver operating characteristic analysis found the percent changes of nRCBV and sRCBV at week 2 and sRCBV at week 16, but not rCBV data at week 8, to be good prognostic markers for OS-1. Patients with positive change from baseline rCBV had significantly shorter OS than those with negative change at both week 2 and week 16 (P = .0015 and P = .0067 for nRCBV and P = .0251 and P = .0004 for sRCBV, respectively).
  
  
  CONCLUSIONS
  Early decreases in rCBV are predictive of improved survival in patients with recurrent GBM treated with bevacizumab.
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Kathleen M
authors: KM
authors: Schmainda
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Zheng
authors: Z
authors: Zhang
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Melissa
authors: M
authors: Prah
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Bradley S
authors: BS
authors: Snyder
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Mark R
authors: MR
authors: Gilbert
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: A Gregory
authors: AG
authors: Sorensen
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Daniel P
authors: DP
authors: Barboriak
authors: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (K.M.S., M.P.); Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island (Z.Z., B.S.S.); Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.R.G.); Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts (A.G.S.); Department of Radiology, Duke University Medical Center, Durham, North Carolina (D.P.B.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island (J.L.B.); Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.).
authors: Jerrold L
authors: JL
authors: Boxerman
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000098:blood supply*; D003287:Contrast Media; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D003287:Contrast Media; D000068258:Bevacizumab; D000077146:Irinotecan; D003606:Dacarbazine; D002166:Camptothecin; D000077204:Temozolomide
keywords: MRI; bevacizumab; overall survival; rCBV; recurrent glioblastoma
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