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Neuro Oncol. 2015 Aug;17(8):1148-56. doi: 10.1093/neuonc/nou364. Epub 2015 Feb 2.

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.

Author information

1
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.).

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.

KEYWORDS:

MRI; bevacizumab; overall survival; rCBV; recurrent glioblastoma

PMID:
25646027
PMCID:
PMC4490871
DOI:
10.1093/neuonc/nou364
[Indexed for MEDLINE]
Free PMC Article

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