Cerebral Blood Flow Changes in Glioblastoma Patients Undergoing Bevacizumab Treatment Are Seen in Both Tumor and Normal Brain.
Bevacizumab (BEV) is increasingly used to treat recurrent glioblastoma (GBM) with some reported improvement in neurocognitive function despite potential neurotoxicities. We examined the effects of BEV on cerebral blood flow (CBF) within recurrent GBM tumor and in the contralateral middle cerebral artery (MCA) territory.Post-chemoradiation patients with histologically confirmed GBM were treated with BEV and underwent routine, serial tumor imaging with additional pseudocontinuous arterial spin labeling (pcASL) following informed consent. Circular regions-of-interest were placed on pcASL images directly over the recurrent tumor and in the contralateral MCA territory. CBF changes before and during BEV treatment were evaluated in tumor and normal tissue. Linear mixed models were used to assess statistical significance.Fifty-three pcASL studies in 18 patients were acquired. Evaluation yielded lower mean tumoral CBF during BEV treatment compared with pre-treatment (45 ± 27 vs. 65 ± 27 ml/100 g/min, p = 0.002), and in the contralateral MCA territory during, compared with pre-BEV treatment (35 ± 8.4 vs. 41 ± 8.4 ml/100 g/min, p = 0.03). The decrease in mean CBF tended to be greater in the tumoral region than in the contralateral MCA, though the difference did not reach statistical significance (31% vs. 13%; p = 0.082).


CONCLUSIONS
BEV administration results in statistically significant global CBF decrease with a potentially preferential decrease in tumor perfusion compared with normal brain tissue.
Department of Radiology, University of Washington; Seattle, WA, USA Department of Radiology, Stanford University, Stanford, CA, USA drjalal@uw.edu.
Jalal B
JB
Andre
Department of Neurology and Neurological Sciences, Stanford University; Stanford, CA, USA.
Seema
S
Nagpal
Department of Radiology, University of Washington; Seattle, WA, USA.
Daniel S
DS
Hippe
Department of Neurological Surgery, University of Washington; Seattle, WA, USA.
Ali C
AC
Ravanpay
Department of Radiology, Stanford University, Stanford, CA, USA.
Heiko
H
Schmiedeskamp
Department of Radiology, Stanford University, Stanford, CA, USA.
Roland
R
Bammer
Department of Radiology, University of Washington; Seattle, WA, USA.
Gerald J
GJ
Palagallo
Department of Neurological Surgery, University of Washington; Seattle, WA, USA.
Lawrence
L
Recht
Department of Radiology, Stanford University, Stanford, CA, USA.
Greg
G
Zaharchuk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001783:Blood Flow Velocity / Q000187:drug effects; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
arterial spin labeling; bevacizumab; cerebral blood flow; glioblastoma; magnetic resonance imaging