Early response evaluation for recurrent high grade gliomas treated with bevacizumab: a volumetric analysis using diffusi
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CLINICAL STUDY
Early response evaluation for recurrent high grade gliomas treated with bevacizumab: a volumetric analysis using diffusion-weighted imaging Eui Jin Hwang • Yongjun Cha • A. Leum Lee • Tae Jin Yun • Tae Min Kim Chul-Kee Park • Ji-Hoon Kim • Chul-Ho Sohn • Sung-Hye Park • Il Han Kim • Dae Seog Heo • Se-Hoon Lee • Seung Hong Choi
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Received: 5 September 2012 / Accepted: 5 February 2013 / Published online: 17 February 2013 Ó Springer Science+Business Media New York 2013
Abstract Bevacizumab is a novel treatment for the recurrent high-grade gliomas (rHGG). However, only a subset of the patients shows response to the bevacizumab treatment and the response evaluation using conventional criteria is difficult. The purpose of our study was to evaluate the early response for rHGG treated with bevacizumab using volumetric analysis of diffusion-weighted imaging (DWI). Twenty-nine patients who received bevacizumab therapy for rHGG were included in our study. All patients received a conventional MRI scan with DWI before and after the initial bevacizumab dose. For each MRI, we measured the total volume of the T2 hyperintense lesion (HT2) of the rHGG, the volume of foci with a lower ADC value than that of the normal cortex (LADC), and the proportion of LADC to HT2 (LADC/HT2). The Changes in the HT2, LADC and LADC/HT2 after bevacizumab treatment were also determined. Thereafter, those volumetric data were compared to the progression free survival (PFS). After the analyses, we found a significant negative correlation between the PFS and the LADC for the post-bevacizumab ADC maps (r = -0.413, P = 0.026).
The patients with an LADC of\2.5 cm3 showed a longer PFS than those with an LADC of C2.5 cm3 (median = 135 vs. 91 days, P = 0.002) on the post-bevacizumab ADC maps. A multiple linear regression analysis revealed that only the postbevacizumab LADC was a significant predictor of the PFS (P = 0.026). In conclusion, the post-bevacizumab LADC can be used for an early response evaluation and can predict the PFS for rHGG patients treated with bevacizumab.
E. J. Hwang A. L. Lee T. J. Yun J.-H. Kim C.-H. Sohn S. H. Choi Department of Radiology, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
S.-H. Park Department of Pathology, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
Y. Cha T. M. Kim D. S. Heo S.-H. Lee (&) Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, South Korea e-mail: [email protected] C.-K. Park Department of Neurosurgery, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
Keywords Bevacizumab Diffusion-weighted imaging Glioblastoma Astrocytoma Prognosis
Introduction Gliomas are the most common primary brain tumor, and the majority are high-grade gliomas (HGGs), including glioblastomas (GBMs) and anaplastic astrocytomas (A
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