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Predictive significance of mean apparent diffusion coefficient value for responsiveness of temozolomide-refractory malignant glioma to bevacizumab: preliminary report

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Abstract

Background

Recurrent glioblastoma after initial radiotherapy plus concomitant and adjuvant temozolomide is problematic. Here, patients with temozolomide-refractory high-grade gliomas were treated with bevacizumab (BV) and evaluated using apparent diffusion coefficient (ADC) for response.

Methods

Nine post-temozolomide recurrent or progressive high-grade glioma patients (seven with glioblastoma and two with anaplastic astrocytoma) were treated with BV monotherapy. Average age was 57 years (range, 22–78), median Karnofsky Performance Scale (KPS) was 70 (30–80) and median BV line number was 2 (2–5). Two had additional stereotactic radiotherapy within 6 months prior to BV. Magnetic resonance (MR) imaging after BV therapy was performed within 2 weeks with calculation of mean ADC (mADC) values of enhancing tumor contours.

Results

Post-BV treatment MR imaging showed decreased tumor volumes in eight of nine cases (88.9 %). Partial response was obtained in four cases (44.4 %), four cases had stable disease, and one had progressive disease. Of 15 evaluable enhancing lesions, 11 shrank and four did not. Pretreatment mADC values were above 1100 (10−6 mm2/s) in all responding tumors, while all non-responding lesions scored below 1100 (p = 0.001). mADC decreased after the first BV treatment in all lesions except one. KPS improved in four cases (44.4 %). Median progression-free survival and overall survival for those having all lesions with high mADC (>1100) were significantly longer than those with a low mADC (<1100) lesion (p = 0.018 and 0.046, respectively).

Conclusions

Bevacizumab monotherapy is effective in patients with temozolomide-refractory recurrent gliomas and tumor mean ADC value can be a useful marker for prediction of BV response and survival.

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Acknowledgments

This work was supported partially by grants of the Ministry of Health, Labour, and Welfare of Japan (H20-ganrinsyou-ippan-019 and 20shi-4) (to MN). We thank Kuninori Kobayashi, RT (Radiology Section, Kyorin University Hospital) for obtaining MR imaging data.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Motoo Nagane, Keiichi Kobayashi, Masaki Tanaka, Saki Shimizu & Yoshiaki Shiokawa

  2. Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Kazuhiro Tsuchiya

  3. Department of Pathology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Yukiko Shishido-Hara

Authors
  1. Motoo Nagane
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  2. Keiichi Kobayashi
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  3. Masaki Tanaka
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  4. Kazuhiro Tsuchiya
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  5. Yukiko Shishido-Hara
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  6. Saki Shimizu
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  7. Yoshiaki Shiokawa
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Correspondence to Motoo Nagane.

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Nagane, M., Kobayashi, K., Tanaka, M. et al. Predictive significance of mean apparent diffusion coefficient value for responsiveness of temozolomide-refractory malignant glioma to bevacizumab: preliminary report. Int J Clin Oncol 19, 16–23 (2014). https://doi.org/10.1007/s10147-013-0517-x

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  • DOI: https://doi.org/10.1007/s10147-013-0517-x

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