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Dokumenttyp:
journal article 
Autor(en):
Kickingereder, Philipp; Wiestler, Benedikt; Graf, Markus; Heiland, Sabine; Schlemmer, Heinz Peter; Wick, Wolfgang; Wick, Antje; Bendszus, Martin; Radbruch, Alexander 
Titel:
Evaluation of dynamic contrast-enhanced MRI derived microvascular permeability in recurrent glioblastoma treated with bevacizumab. 
Abstract:
Bevacizumab, an antibody to vascular endothelial growth factor, is commonly used in the setting of recurrent glioblastoma (rGB). The aim of the present study was to evaluate whether dynamic-contrast-enhanced MRI (DCE-MRI) derived microvascular permeability is related to bevacizumab treatment outcome in rGB. Twenty-two patients with rGB underwent DCE-MRI at a median of 2.6 weeks prior initializing bevacizumab therapy. Follow-up MRI-scans (DCE-MRI available for 19/22 patients) were obtained after a median of 9.9 weeks. The volume transfer constant (K(trans))--an estimate related to microvascular permeability--at baseline and voxel-wise-reduction (VWR) in K(trans) at first follow-up were measured from the entire contrast-enhancing tumor (CET) and correlated with progression-free and overall survival (PFS, OS) using uni- and multivariate cox-regression (significance-level p< 0.05). Baseline K(trans) ranged from 0.050 to 0.205 min(-1) (median, 0.109 min(-1)). The VWR in K(trans) ranged from 19.9 to 97.2 % (median, 89.4 %). Patients with lower baseline K(trans) and higher VWR in K(trans) showed significantly longer PFS and OS. Given the strong correlation of VWR in K(trans) and CET-volume changes (Spearman's ? = -0.73, p< 0.01) both variables were included in a multivariate model. Thereby, neither VWR in K(trans) nor CET-volume changes retained independent significance for PFS or OS. Pre-treatment K(trans) stratifies PFS and OS in patients with bevacizumab-treated rGB. Although early pharmacodynamics changes in K(trans) were not assessed, the VWR in K(trans) at first follow-up had no additional benefit over assessment of CET-volume changes. Further prospective trials are needed to confirm these findings and to elucidate the potential role of pre-treatment K(trans) as a predictive and/or prognostic biomarker. 
Zeitschriftentitel:
J Neurooncol 
Jahr:
2015 
Band / Volume:
121 
Heft / Issue:
Seitenangaben Beitrag:
373-80 
Sprache:
eng 
Print-ISSN:
0167-594X 
TUM Einrichtung:
Abteilung für Neuroradiologie