Large-volume low apparent diffusion coefficient lesions predict poor survival in bevacizumab-treated glioblastoma patients Journal Article


Authors: Zhang, M.; Gulotta, B.; Thomas, A.; Kaley, T.; Karimi, S.; Gavrilovic, I.; Woo, K. M.; Zhang, Z.; Arevalo-Perez, J.; Holodny, A. I.; Rosenblum, M.; Young, R. J.
Article Title: Large-volume low apparent diffusion coefficient lesions predict poor survival in bevacizumab-treated glioblastoma patients
Abstract: Background. Glioblastomas treated with bevacizumab may develop low-signal apparent diffusion coefficient (low-ADC) lesions, which may reflect increased tumor cellularity or atypical necrosis. The purpose of this study was to examine the relationship between low-ADC lesions and overall survival (OS). We hypothesized that growing low-ADC lesions would be associated with shorter OS. Methods. We retrospectively identified 52 patients treated with bevacizumab for the first (n = 42, 81%) or later recurrence of primary glioblastoma, who had low-ADC lesions and 2 post-bevacizumab scans ≤90 days apart. Low-ADC lesion volumes were measured, and normalized 5th percentile histogram low-ADC values were recorded. Using OS as the primary endpoint, semiparametric Cox models were fitted to ascertain univariate and multivariate hazard ratios (HRs) with significance at P =. 05. Results. Median OS was 9.1 months (95% CI = 7.2-14.3). At the second post-bevacizumab scan, the volume of the low-ADC lesion (median: 12.94 cm3) was inversely associated with OS, with larger volumes predicting shorter OS (HR = 1.014 [95% CI = 1.003-1.025], P =. 009). The percent change in low-ADC volume (median: 6.8%) trended toward increased risk of death with growing volumes (P =. 08). Normalized 5th percentile low-ADC value and its percent change were not associated with OS (P >. 51). Also correlated with shorter OS were the pre-bevacizumab nonenhancing volume (P =. 025), the first post-bevacizumab enhancing volume (P =. 040), and the second post-bevacizumab enhancing volume (P =. 004). Conclusions. The volume of low-ADC lesions at the second post-bevacizumab scan predicted shorter OS. This suggests that low-ADC lesions may be considered important imaging markers and included in treatment decision algorithms. © 2015 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved.
Keywords: bevacizumab; diffusion; glioblastoma; apparent diffusion coefficient; (adc)
Journal Title: Neuro-Oncology
Volume: 18
Issue: 5
ISSN: 1522-8517
Publisher: Oxford University Press  
Date Published: 2016-05-01
Start Page: 735
End Page: 743
Language: English
DOI: 10.1093/neuonc/nov268
PROVIDER: scopus
PMCID: PMC4827045
PUBMED: 26538618
DOI/URL:
Notes: Article -- Export Date: 2 June 2016 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    244 Zhang
  2. Robert J Young
    114 Young
  3. Marc Rosenblum
    257 Rosenblum
  4. Sasan Karimi
    97 Karimi
  5. Thomas Kaley
    91 Kaley
  6. Andrei Holodny
    136 Holodny
  7. Alissa A Thomas
    15 Thomas
  8. Kaitlin Marie Woo
    98 Woo
  9. Myron   Zhang
    1 Zhang