Journal of neuro-oncology · 2026
Diffusion histogram analysis predicts progression-free survival in contrast enhancing recurrent IDH mutant gliomas treated with bevacizumab.
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Loxterkamp Elizabeth, Luo Audrey, Sanvito Francesco, Le Collin T, Raymond Catalina, Yang Chuyin, Prins Terry J, Fisher Addison, Salamon Noriko, Liau Linda M, Chong Robert A, Nghiemphu Phioanh L, Nathanson David A, Cloughesy Timothy F, Lai Albert, Ellingson Benjamin M
Аннотация
BACKGROUND: Pretreatment apparent diffusion coefficient (ADC) histogram analysis-specifically the lower Gaussian peak mean (ADC-L)-is a predictive biomarker of progression-free survival (PFS) and overall survival (OS) in recurrent IDH-wildtype glioblastoma receiving anti-VEGF treatment including bevacizumab. IDH-mutant gliomas differ biologically from glioblastoma, as they exhibit lower tumor cellularity, longer survival, and distinct sensitivity to a variety of therapies. Whether ADC-L retains predictive utility in IDH-mutant recurrent glioma has not been established.
METHODS: In this retrospective, single-center study, sixty patients with IDH-mutant recurrent glioma (41 astrocytoma, 19 oligodendroglioma) with measurable contrast enhancement and available pretreatment diffusion-weighted MRI who received bevacizumab were analyzed. Univariate and multivariate Cox regression and Kaplan-Meier analyses were performed for PFS and OS.
RESULTS: The optimal ADC-L threshold was 1.19 μm2/ms. High ADC-L (≥1.19 μm2/ms) was associated with significantly longer PFS (median 5.46 vs. 2.76 months; p = 0.006) but not OS. In multivariate analysis, low ADC-L (HR = 2.054; p = 0.0228) and astrocytoma histology (HR = 2.295; p = 0.0158) were independent predictors of shorter PFS when accounting for number of prior recurrences. ADC-L was also significant predictor of PFS in both astrocytoma and oligodendroglioma patients, independently, after accounting for number of recurrences.
CONCLUSIONS: Pretreatment ADC-L predicts PFS in IDH-mutant recurrent glioma receiving bevacizumab. Supporting prospective evaluation of ADC-L as a biomarker for bevacizumab patient selection in this population.
METHODS: In this retrospective, single-center study, sixty patients with IDH-mutant recurrent glioma (41 astrocytoma, 19 oligodendroglioma) with measurable contrast enhancement and available pretreatment diffusion-weighted MRI who received bevacizumab were analyzed. Univariate and multivariate Cox regression and Kaplan-Meier analyses were performed for PFS and OS.
RESULTS: The optimal ADC-L threshold was 1.19 μm2/ms. High ADC-L (≥1.19 μm2/ms) was associated with significantly longer PFS (median 5.46 vs. 2.76 months; p = 0.006) but not OS. In multivariate analysis, low ADC-L (HR = 2.054; p = 0.0228) and astrocytoma histology (HR = 2.295; p = 0.0158) were independent predictors of shorter PFS when accounting for number of prior recurrences. ADC-L was also significant predictor of PFS in both astrocytoma and oligodendroglioma patients, independently, after accounting for number of recurrences.
CONCLUSIONS: Pretreatment ADC-L predicts PFS in IDH-mutant recurrent glioma receiving bevacizumab. Supporting prospective evaluation of ADC-L as a biomarker for bevacizumab patient selection in this population.