Early Cerebral Blood Volume Changes Predict Progression After Convection-Enhanced Delivery of Topotecan for Recurrent Malignant Glioma.
Early Cerebral Blood Volume Changes Predict Progression After Convection-Enhanced Delivery of Topotecan for Recurrent Malignant Glioma.
复制标题
早期脑血容量变化可预测对流增强拓扑替康治疗复发性恶性胶质瘤后的进展。
DOI：
10.1016/j.wneu.2015.03.008
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发表时间：
2015
影响因子：
2
通讯作者：
Bruce,JeffreyN
中科院分区：
文献类型：
--
作者：
Surapaneni,Krishna;Kennedy,BenjaminC;Yanagihara,TedK;DeLaPaz,Robert;Bruce,JeffreyN
目的评估复发性恶性胶质瘤患者在对流增强输注拓扑替康后1个月增强肿瘤体积（eTV）和相对脑血容量（rCBV）的早期变化是否与6个月疾病进展状态相关。方法16例患者参加了一项对流增强输送拓扑替康治疗复发性恶性胶质瘤的Ib期试验。每位患者在基线和每隔4至8周进行连续随访磁共振成像评估。与基线相比，1个月时eTV和rCBV的变化被评估为6个月进展状态的潜在预测因素，分为进展性疾病或非进展性疾病。使用logistic回归分析估计1个月时eTV和rCBV百分比变化与6个月时疾病进展概率之间的关系。以病情进展6个月为参照，评估eTV和rCBV不同百分比变化阈值的受试者工作特征曲线。结果进展性疾病患者1个月时rCBV变化百分比与非进展性疾病患者6个月时差异有统计学意义（+12% vs - 29%，P= 0.02）。Logistic回归分析显示，在对流增强输注topotecan后1个月rCBV增加10%与6个月进展性疾病的几率增加1.7倍相关（95%置信区间[CI] 1.0-2.9P = 0.05）。用于确定6个月进展性疾病的受试者工作特征分析显示，rCBV曲线下面积（0.867;95% CI 0.66-1.00）大于肿瘤体积增强变化（0.767;95% CI 0.51-1.00）。结论：在接受对流增强输送拓扑替康治疗的复发性恶性胶质瘤患者中，治疗后4周rCBV的早期变化可能有助于预测6个月时的进展情况。
ObjectiveTo assess whether early changes in enhancing tumor volume (eTV) and relative cerebral blood volume (rCBV) 1 month after convection-enhanced delivery of topotecan in patients with recurrent malignant glioma correlated with 6-month disease progression status.MethodsSixteen patients were enrolled in a Phase Ib trial of convection-enhanced delivery of topotecan for recurrent malignant glioma. Each patient was evaluated with serial follow-up magnetic resonance imaging at baseline and at 4- to 8-week intervals. Changes at 1 month compared with baseline in eTV and rCBV were evaluated as potential predictors of 6-month progression status, classified as either progressive disease or nonprogressive disease. Relationships between percent changes in eTV and rCBV at 1 month with the probability of progressive disease at 6 months were estimated by the use of logistic regression analysis. Receiver operating characteristic curves for varying percent change thresholds in eTV and rCBV were evaluated by the use of 6-month progressive disease as the reference.ResultsThere was a significant difference in the percent change in rCBV at 1 month in patients with progressive disease compared with those with nonprogressive disease at 6 months (+12% vs. −29%,P= 0.02). Logistic regression analysis demonstrated on average that a 10% increase in rCBV at 1 month after convection-enhanced delivery of topotecan was associated with 1.7 times the odds of developing progressive disease at 6 months (95% confidence interval [CI] 1.0–2.9P= 0.05). Receiver operating characteristic analysis for determining progressive disease at 6 months showed a greater area under the curve with rCBV (0.867; 95% CI 0.66–1.00) than with change in enhancing tumor volume (0.767; 95% CI 0.51–1.00).ConclusionIn this selected population of patients with recurrent malignant glioma treated with convection-enhanced delivery of topotecan, early changes in rCBV at 4 weeks after therapy may help predict progression status at 6 months.