BACKGROUND Diffusion magnetic resonance (MR) characteristics are a predictive imaging biomarker for survival benefit in recurrent glioblastoma treated with anti-vascular endothelial growth factor (VEGF) therapy; however, its use in large volume recurrence has not been evaluated. OBJECTIVE To determine if diffusion MR characteristics can predict survival outcomes in patients with large volume recurrent glioblastoma treated with bevacizumab or repeat resection. METHODS A total of 32 patients with large volume (>20 cc or > 3.4 cm diameter) recurrent glioblastoma treated with bevacizumab and 35 patients treated with repeat surgery were included. Pretreatment tumor volume and apparent diffusion coefficient (ADC) histogram analysis were used to phenotype patients as having high (>1.24 μm2/ms) or low (<1.24 μm2/ms) ADCL, the mean value of the lower peak in a double Gaussian model of the ADC histogram within the contrast enhancing tumor. RESULTS In bevacizumab and surgical cohorts, volume was correlated with overall survival (Bevacizumab: P = .009, HR = 1.02; Surgical: P = .006, HR = 0.96). ADCL was an independent predictor of survival in the bevacizumab cohort (P = .049, HR = 0.44), but not the surgical cohort (P = .273, HR = 0.67). There was a survival advantage of surgery over bevacizumab in patients with low ADCL (P = .036, HR = 0.43) but not in patients with high ADCL (P = .284, HR = 0.69). CONCLUSION Pretreatment diffusion MR imaging is an independent predictive biomarker for overall survival in recurrent glioblastoma with a large tumor burden. Large tumors with low ADCL have a survival benefit when treated with surgical resection, whereas large tumors with high ADCL may be best managed with bevacizumab.

中文翻译：

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扩散磁共振成像表型可预测贝伐单抗或手术治疗具有大肿瘤负担的复发性胶质母细胞瘤的总体生存获益

背景 弥散磁共振 (MR) 特征是一种预测成像生物标志物，可预测用抗血管内皮生长因子 (VEGF) 疗法治疗的复发性胶质母细胞瘤的生存获益；然而，尚未评估其在大体积复发中的应用。目的 确定扩散 MR 特征是否可以预测接受贝伐单抗治疗或重复切除的大体积复发性胶质母细胞瘤患者的生存结果。方法 共纳入 32 名接受贝伐珠单抗治疗的大体积（>20 cc 或 > 3.4 cm 直径）复发性胶质母细胞瘤患者和 35 名接受重复手术治疗的患者。治疗前肿瘤体积和表观扩散系数 (ADC) 直方图分析用于将患者表型为具有高 (>1.24 μm2/ms) 或低 (<1.24 μm2/ms) ADCL，对比增强肿瘤内ADC直方图的双高斯模型中下峰的平均值。结果 在贝伐单抗和手术队列中，体积与总生存期相关（贝伐单抗：P = .009，HR = 1.02；手术：P = .006，HR = 0.96）。ADCL 是贝伐单抗队列中生存率的独立预测因子（P = .049，HR = 0.44），但不是手术队列（P = .273，HR = 0.67）。手术在低 ADCL 患者（P = .036，HR = 0.43）中优于贝伐单抗，但在高 ADCL 患者中没有（P = .284，HR = 0.69）。结论 治疗前扩散 MR 成像是具有大肿瘤负荷的复发性胶质母细胞瘤总体生存率的独立预测生物标志物。具有低 ADCL 的大肿瘤在接受手术切除治疗时具有生存益处，