Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton MR Spectroscopic Imaging Study

• Published in: American journal of neuroradiology : AJNR Vol. 33; no. 11; pp. 2095 - 2102
• Main Authors: JEON, J. Y, KOVANLIKAYA, I, TSIOURIS, A. J, BOOCKVAR, J. A, MAO, X, SHIN, B, BURKHARDT, J. K, KESAVABHOTLA, K, CHRISTOS, P, RIINA, H, SHUNGU, D. C
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01.12.2012
• Subjects: Aged; Angiogenesis Inhibitors - administration & dosage; Antibodies, Monoclonal, Humanized - administration & dosage; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Bevacizumab; Biological and medical sciences; Brain; Brain - drug effects; Brain - metabolism; Brain Neoplasms - drug therapy; Brain Neoplasms - metabolism; Cardiovascular system; Cerebral Arteries; Choline - metabolism; Female; Glioblastoma - drug therapy; Glioblastoma - metabolism; Humans; Infusions, Intra-Arterial; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Spectroscopy - methods; Male; Medical sciences; Middle Aged; Nervous system; Protons; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Treatment Outcome; Malignant glioma; Nervous system diseases; MR spectroscopic imaging; Radiodiagnosis; Central nervous system disease; Central nervous system; Glioblastoma; Proton; Malignant tumor; Cancer; Encephalon
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A3091

SIACI of bevacizumab has emerged as a promising novel therapy in the treatment of recurrent GB. This study assessed the potential of (1)H-MRS as an adjunctive technique in detecting metabolic changes reflective of antiproliferative effects of targeted infusion of bevacizumab in the treatment of GB. Eighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included. Concurrent MR imaging and (1)H-MRS scans were performed before and after treatment. Five distinct morphologic ROIs were evaluated for structural and metabolic changes on MR imaging and (1)H-MRS, which included enhancing, nonenhancing T2 hyperintense signal abnormality, and multiple control regions. Pre- and post-SIACI of bevacizumab peak areas for NAA, tCho, tCr, as well as tCho/tCr and tCho/NAA ratios, were derived for all 5 ROIs and compared using the Wilcoxon signed-rank test. A significant median decrease of 25.99% (range -55.76 to 123.94; P = .006) in tCho/NAA was found post-SIACI of bevacizumab relative to pretreatment values in regions of enhancing disease. A trend-level significant median decrease of 6.45% (range -23.71 to 37.67; P = .06) was noted in tCho/NAA posttreatment in regions of nonenhancing T2-hyperintense signal abnormality. The results of this (1)H-MRS analysis suggest that GB treatment with SIACI of bevacizumab may be associated with a direct antiproliferative effect, as demonstrated by significant reductions of tCho/NAA after the intervention.