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
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
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DOI：
10.1093/neuonc/nou364
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发表时间：
2015-08-01
期刊：
影响因子：
15.9
通讯作者：
Boxerman, Jerrold L.
中科院分区：
文献类型：
--
作者：
Schmainda, Kathleen M.;Zhang, Zheng;Boxerman, Jerrold L.
背景。该研究的目的是确定在治疗开始后 2、8 和 16 周测量时，动态磁敏对比 (DSC) MRI 得出的相对脑血容量 (rCBV) 的变化是否可以预测复发性多形性胶质母细胞瘤 (GBM) 患者的总生存期 (OS)。 方法。复发性 GBM 患者 (37/123) 参加了 ACRIN 6677/RTOG 0625（一项贝伐珠单抗联合伊立替康或替莫唑胺的多中心、随机、II 期试验），同意接受 DSC-MRI 加传统 MRI，其中 21 名患者在基线时接受 DSC-MRI，并至少进行 1 次基线后扫描。使用对比前和对比后 T1 加权图像半自动确定对比增强感兴趣区域。针对这些感兴趣区域确定了标准化为白质的平均肿瘤 rCBV (nRCBV) 和标准化 rCBV (sRCBV)。使用 Wilcoxon 秩和和 Kaplan-Meier 生存估计与对数秩检验比较 nRCBV 和 sRCBV 较基线发生正变化和负变化的患者的 OS 率。结果。存活至少 1 年 (OS-1) 的患者在第 2 周时 nRCBV (P=.0451) 和第 16 周时 sRCBV (P=.014) 显着下降。受试者操作特征分析发现，第 2 周的 nRCBV 和 sRCBV 以及第 16 周的 sRCBV 变化百分比，但不是第 8 周的 rCBV 数据，是 OS-1 良好的预后标志。在第 2 周和第 16 周，rCBV 较基线呈正变化的患者的 OS 显着短于负变化的患者（nRCBV 分别为 P=.0015 和 P=.0067，sRCBV 分别为 P=.0251 和 P=.0004）。结论。 rCBV 的早期下降预示着接受贝伐珠单抗治疗的复发性 GBM 患者的生存率会提高。
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.