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Histogram analysis of apparent diffusion coefficient within enhancing and nonenhancing tumor volumes in recurrent glioblastoma patients treated with bevacizumab

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Abstract

While patients with recurrent glioblastoma receiving anti-angiogenic therapy demonstrate significant response rates, the benefit on patient survival is less clear. We assessed whether histogram analysis of diffusion weighted MRI can stratify for progression-free and overall survival. Baseline and 3–6 week post-treatment MRI exams of 91 patients with recurrent glioblastoma treated with bevacizumab were retrospectively evaluated. Histograms of apparent diffusion coefficient (ADC) within the volume of contrast enhancing and nonenhancing T2/FLAIR lesions were analyzed using curve-fit analysis. Overall survival (OS) and progression-free survival (PFS) were assessed using ADC parameters in a Cox proportional hazards model adjusted for clinical variables. Baseline ADCL/ADCM within nonenhancing T2/FLAIR volume (> or ≤0.64) can stratify OS (HR = 2.24, p = 0.002) and PFS (HR = 1.90, p = 0.005). %ADCH within enhancing T1+C volume (> or ≤25 %) can also stratify OS (HR = 0.59, p = 0.034) and PFS (HR = 0.56, p = 0.01). Stratification of patient survival can be improved by merging these two ADC parameters into a single combined ADC factor (HR = 0.17, p < 0.0001). The median OS ratio of patient groups stratified by this combined factor was 2.03, larger than median OS ratio when stratifying by either %ADCH within T1+C volume alone (1.3) or ADCL/ADCM within T2/FLAIR alone (1.86). ADC histogram analysis within both enhancing and nonenhancing components of tumor can be used to stratify for PFS and OS in patients with recurrent glioblastoma.

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Acknowledgments

None.

Conflict of interest

Drs. Wen and Reardon have research support and have served on an advisory board for Genentech.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Rifaquat Rahman

  2. Center of Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Alhafidz Hamdan, Rebecca Zweifler, Han Jiang, Andrew D. Norden, David A. Reardon & Patrick Y. Wen

  3. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Srinivasan Mukundan & Raymond Y. Huang

Authors
  1. Rifaquat Rahman
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  2. Alhafidz Hamdan
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  3. Rebecca Zweifler
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  4. Han Jiang
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  5. Andrew D. Norden
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  6. David A. Reardon
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  7. Srinivasan Mukundan
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  8. Patrick Y. Wen
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  9. Raymond Y. Huang
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Correspondence to Raymond Y. Huang.

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Rahman, R., Hamdan, A., Zweifler, R. et al. Histogram analysis of apparent diffusion coefficient within enhancing and nonenhancing tumor volumes in recurrent glioblastoma patients treated with bevacizumab. J Neurooncol 119, 149–158 (2014). https://doi.org/10.1007/s11060-014-1464-8

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  • DOI: https://doi.org/10.1007/s11060-014-1464-8

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