Prognosis prediction of measurable enhancing lesion after completion of standard concomitant chemoradiotherapy and adjuvant temozolomide in glioblastoma patients: application of dynamic susceptibility contrast perfusion and diffusion-weighted imaging

PLoS One. 2014 Nov 24;9(11):e113587. doi: 10.1371/journal.pone.0113587. eCollection 2014.

Abstract

Purpose: To assess the prognosis predictability of a measurable enhancing lesion using histogram parameters produced by the normalized cerebral blood volume (nCBV) and normalized apparent diffusion coefficient (nADC) after completion of standard concomitant chemoradiotherapy (CCRT) and adjuvant temozolomide (TMZ) medication in glioblastoma multiforme (GBM) patients.

Materials and methods: This study was approved by the institutional review board (IRB), and the requirement for informed consent was waived. A total of 59 patients with newly diagnosed GBM who received standard CCRT with TMZ and adjuvant TMZ for six cycles underwent perfusion-weighted and diffusion-weighted imaging. Twenty-seven patients had a measurable enhancing lesion and 32 patients lacked a measurable enhancing lesion based on the Response Assessment in Neuro-Oncology (RANO) criteria in the follow-up MRI, which was performed within 3 months after adjuvant TMZ therapy was completed. We measured the nCBV and nADC histogram parameters based on the measurable enhancing lesion. The progression free survival (PFS) was analyzed by the Kaplan-Meier method with the use of the log-rank test.

Results: The median PFS of patients lacking measurable enhancing lesion was longer than for those with measurable enhancing lesions (17.6 vs 3.3 months, P<.0001). There was a significant, positive correlation between the 99th percentile nCBV value of a measurable enhancing lesion and the PFS (P= .044, R(2)= .152). In addition, the median PFS was longer in patients with a 99th percentile nCBV value ≧ 4.5 than it was in those with a value <4.5 (4.4 vs 3.1 months, P = .036).

Conclusion: We found that the nCBV value can be used for the prognosis prediction of a measurable enhancing lesion after the completion of standard treatment for GBM, wherein a high 99th percentile nCBV value (≧ 4.5) suggests a better PFS for GBM patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / therapy*
  • Chemoradiotherapy
  • Chemotherapy, Adjuvant
  • Child
  • Contrast Media
  • Dacarbazine / analogs & derivatives*
  • Dacarbazine / therapeutic use
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / therapy*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Prognosis
  • Radiography
  • Temozolomide
  • Young Adult

Substances

  • Antineoplastic Agents, Alkylating
  • Contrast Media
  • Dacarbazine
  • Temozolomide

Grants and funding

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1120300), the Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs (A112028 and HI13C0015), and the Research Center Program of IBS (Institute for Basic Science) in Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.