![]() ![]() Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO. 1330) and bevacizumab-treated (log-rank, P =. (F) Kaplan-Meier curves showing no differences in OS based on ADC H higher or lower than 1.6 μm 2/ms for both bevacizumab-naïve (log-rank, P =. No differences in OS were observed between patients treated with bevacizumab and those who were not within high ADC L (log-rank, P =. 0130) and bevacizumab-treated (log-rank, P =. ![]() (E) Kaplan-Meier curves showing differences in OS based on ADC L higher or lower than 1.0 μm 2/ms for both bevacizumab-naïve (log-rank, P =. 0487) but not when accounting for age and ADC L (Cox multivariate, P =. (D) Kaplan-Meier curves showing significantly lower OS in patients with ADC H < 1.6 μm 2/ms in univariate analysis (log-rank, P =. (C) Kaplan-Meier curves showing significantly lower OS in patients with ADC L < 1.0 μm 2/ms (log-rank, P =. 0012) however, ADC H was not significant in multivariate analysis (Cox multivariate, P =. (B) Kaplan-Meier curves showing significantly lower PFS in patients with ADC H < 1.6 μm 2/ms in univariate analysis (log-rank, P =. (A) Kaplan-Meier curves showing significantly lower PFS in patients with ADC L < 1.0 μm 2/ms (log-rank, P <. 527) when patients were stratified by OS12. No significant differences were observed in measurements of ADC L ( t test, P =. (D) ADC L and ADC H measurements for individual tumors categorized based on death before or after 12 months from the start of adjuvant TMZ (OS12). (C) ROC curve showing the sensitivity and specificity of ADC L and ADC H in detecting patients who died within 12 months of starting adjuvant TMZ (OS12) (ADC L ROC AUC = 0.6176 ± 0.06551 SEM, P =. ![]() 412) were observed between patients progressing before and after 6 months from the start of adjuvant TMZ. Significant differences in ADC L ( t test, P =. (B) ADC L and ADC H measurements for individual tumors categorized based on progression before or after 6 months from the start of adjuvant TMZ (PFS6). (A) ROC curve showing the sensitivity and specificity of ADC L and ADC H in detecting patients who progressed within 6 months of starting adjuvant TMZ (PFS6) (ADC L: ROC AUC = 0.6820 ± 0.05252 SEM, P =. Results suggest ADC histogram analysis may be useful for patient risk stratification following completion of RT+TMZ.ĪDC Histogram Analysis Diffusion MRI Glioblastoma. In summary, newly diagnosed glioblastoma patients with low ADC L after completion of RT+TMZ are likely to progress and die earlier than patients with higher ADC L. ADC H was not predictive of PFS or OS when accounting for age and ADC L. OS was significantly shorter with low ADC L tumors, showing a median OS of 407 vs. Results suggest patients with low ADC L had significantly shorter PFS (Cox Hazard Ratio = 0.12, P = 0.0006). ![]() An ADC L value of 1.0 um 2/ms and ADC H value of 1.6 um 2/ms were used to stratify patients into high and low risk categories. A double Gaussian mixed model was used to describe the ADC histograms within the enhancing tumor, where ADC L and ADC H were defined as the mean ADC value of the lower and higher Gaussian distribution, respectively. MRI was performed after completion of RT+TMZ, prior to initiation of adjuvant TMZ. To test this hypothesis we evaluated 120 patients with newly diagnosed GBM receiving RT+TMZ followed by adjuvant TMZ. We hypothesized patients with low diffusivity measured using apparent diffusion coefficient (ADC) histogram analysis evaluated after RT+TMZ, prior to adjuvant TMZ, would have a significantly shorter progression-free (PFS) and overall survival (OS). The standard of care for newly diagnosed glioblastoma (GBM) is surgery, then radiotherapy (RT) with concurrent temozolomide (TMZ), followed by adjuvant TMZ. ![]()
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