Prognostic significance of serum alpha 1-acid glycoprotein in patients with glioblastoma multiforme: a preliminary communication.

2058 Background: To determine the prognostic significance of changes in parameters derived from diffusion tensor imaging (DTI) that occur in response to combination chemotherapy with the antiangiogenesis agent bevacizumab (BEV) in patients with recurrent glioblastoma multiforme (GBM). Methods: 16 patients (10 men, 6 women; age range 38–62 years) with recurrent GBM underwent serial 1.5T MR imaging. Axial single-shot echo planar DTI (TR/TE 6000/100; flip angle 90 degrees; voxel: 1.72 x 1.72 x 5mm; b value of 1000 sec/mm2; 12 directions) was obtained on scans performed 3 days and 1 day prior to and 1 day after initiation of therapy with BEV and irinotecan (CPT-11). Clinical follow-up and survival status was documented up to 20 months after the date of initial MR imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were aligned to whole brain contrast-enhanced 3D FLASH and 3D FLAIR image volumes (1 mm isotropic voxels) using a rigid body normalized mutual information algorithm. Based on two pre-treatment scans, the 95% confidence limits for change (95%CL) in ADC and FA were calculated in volumes of tumor-related contrast-enhancement (TRE) and FLAIR signal abnormality (FSA). A patient was considered to have a change in FA or ADC after therapy if the difference between the pre- and post-treatment values was greater than the 95% CL for that parameter. Progression was defined on contrast-enhanced MRI using MacDonald criteria by neuro-oncologists blinded to the DTI findings. Survival was compared using the log rank test. Results: DTI detected a change in ADC within FSA after therapy in three patients (2 increased, 1 decreased). Patients with a change in ADC within FSA had significantly shorter overall (p < 0.0012) and progression free (p < 0.015) survival than those with no change. Median survival in the patient group with a change in ADC was 24.7 (95% CI [17.3, 39.4]) weeks and 56.4 (95% CI [41.7, 96]) weeks in those patients with no change. Conclusions: In patients with GBM treated with BEV and CPT-11, a change in ADC after therapy in areas of FSA is associated with decreased survival. Parameters derived from DTI may, therefore, potentially serve as early markers of treatment failure in patients with GBM. [Table: see text]

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Prognostic Significance of Bromodeoxyuridine Labeling in Primary and Recurrent Glioblastoma Multiforme

Neurosurgery ◽

10.1097/00006123-199408000-00003 ◽

1994 ◽

Vol 35 (2) ◽

pp. 192???198 ◽

Cited By ~ 1

Author(s):

Ann M. Ritter ◽

Raymond Sawaya ◽

Kenneth R. Hess ◽

Victor A. Levin ◽

Janet M. Bruner

Keyword(s):

Glioblastoma Multiforme ◽

Prognostic Significance ◽

Recurrent Glioblastoma ◽

Recurrent Glioblastoma Multiforme

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Prognostic Significance of Subventricular Zone Enhancement for Recurrent Glioblastoma Multiforme

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.06.857 ◽

2016 ◽

Vol 96 (2) ◽

pp. E105

Author(s):

P. Blumenfeld ◽

M. Guryildirim ◽

G. Tolekidis ◽

J.Y. Shin ◽

D. Chan ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Subventricular Zone ◽

Prognostic Significance ◽

Recurrent Glioblastoma ◽

Recurrent Glioblastoma Multiforme

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Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults

Journal of Neurosurgery ◽

10.3171/jns.2005.102.4.0622 ◽

2005 ◽

Vol 102 (4) ◽

pp. 622-628 ◽

Cited By ~ 77

Author(s):

Andrew T. Parsa ◽

Scott Wachhorst ◽

Kathleen R. Lamborn ◽

Michael D. Prados ◽

Michael W. McDermott ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Tumor Progression ◽

Prognostic Significance ◽

Type I ◽

Type Ii ◽

Content Type ◽

Type Iii ◽

Multifocal Lesions ◽

Tumor Dissemination ◽

Fine Print

Object. The clinical outcome and treatment of adult patients with disseminated intracranial glioblastoma multiforme (GBM) is unclear. The objective in the present study was to assess the prognostic significance of disseminated intracranial GBM in adults at presentation and at the time of tumor progression. Methods. Clinical data from 1491 patients older than 17 years and harboring a GBM that had been diagnosed between 1988 and 1998 at the University of California at San Francisco neurooncology clinic were retrospectively reviewed. Dissemination of the GBM (126 patients) was determined based on Gd-enhanced magnetic resonance images. Classification of dissemination was as follows: Type I, single lesion with subependymal or subarachnoid spread; Type II, multifocal lesions without subependymal or subarachnoid spread; and Type III, multifocal lesions with subependymal or subarachnoid spread. Subgroups of patients were compared using Kaplan—Meier curves that depicted survival probability. The median postprogression survival (PPS), defined according to neuroimaging demonstrated dissemination, was 37 weeks for Type I (23 patients), 25 weeks for Type II (50 patients), and 10 weeks for Type III spread (19 patients). Patients with dissemination at first tumor progression (52 patients) overall had a shorter PPS than those in a control group with local progression, after adjusting for age, Karnofsky Performance Scale score, and time from tumor diagnosis to its progression (311 patients). When analyzed according to tumor dissemination type, PPS was significantly shorter in patients with Type II (33 patients, p < 0.01) and Type III spread (11 patients, p < 0.01) but not in those with Type I spread (eight patients, p = 0.18). Conclusions. Apparently, the presence of intracranial tumor dissemination on initial diagnosis does not in itself preclude aggressive treatment if a patient is otherwise well. A single focus of GBM that later demonstrates Type I dissemination on progression does not have a worse prognosis than a lesion that exhibits only local recurrence.

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