Apparent diffusion coefficient changes predict survival after intra-arterial bevacizumab treatment in recurrent glioblastoma.
OBJECTIVE
Superselective intra-arterial cerebral infusion (SIACI) of bevacizumab (BV) has emerged as a novel therapy in the treatment of recurrent glioblastoma (GB). This study assessed the use of apparent diffusion coefficient (ADC) in predicting length of survival after SIACI BV and overall survival in patients with recurrent GB.


METHODS
Sixty-five patients from a cohort enrolled in a phase I/II trial of SIACI BV for treatment of recurrent GB were retrospectively included in this analysis. MR imaging with a diffusion-weighted (DWI) sequence was performed before and after treatment. ROIs were manually delineated on ADC maps corresponding to the enhancing and non-enhancing portions of the tumor. Cox and logistic regression analyses were performed to determine which ADC values best predicted survival.


RESULTS
The change in minimum ADC in the enhancing portion of the tumor after SIACI BV therapy was associated with an increased risk of death (hazard ratio = 2.0, 95% confidence interval(CI) [1.04-3.79], p = 0.038), adjusting for age, tumor size, BV dose, and prior IV BV treatments. Similarly, the change in ADC after SIACI BV therapy was associated with greater likelihood of surviving less than 1 year after therapy (odds ratio = 7.0, 95% CI [1.08-45.7], p = 0.04). Having previously received IV BV was associated with increased risk of death (OR 18, 95% CI [1.8-180.0], p = 0.014).


CONCLUSIONS
In patients with recurrent GB treated with SIACI BV, the change in ADC value after treatment is predictive of overall survival.
Weill Cornell Medicine, Department of Radiology, 520 East 70th St, New York, NY, 10021, USA. nag2021@med.cornell.edu.
Naveen
http://orcid.org/0000-0002-9341-3079
N
Galla
Weill Cornell Medicine, Department of Radiology, 520 East 70th St, New York, NY, 10021, USA.
Gloria
G
Chiang
Northwell Health, Department of Neurosurgery, New York, NY, USA.
Shamik
S
Chakraborty
Weill Cornell Medicine, Department of Radiology, 520 East 70th St, New York, NY, 10021, USA.
Ranjodh
R
Singh
Weill Cornell Medicine, Department of Radiology, 520 East 70th St, New York, NY, 10021, USA.
A
A
John Tsiouris
Northwell Health, Department of Neurosurgery, New York, NY, USA.
John
J
Boockvar
Weill Cornell Medicine, Department of Radiology, 520 East 70th St, New York, NY, 10021, USA.
Ilhami
I
Kovanlikaya
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D020533:Angiogenesis Inhibitors; D003287:Contrast Media; D000068258:Bevacizumab
ADC; Bevacizumab; Glioblastoma