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"Coss, Peter R"
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Radio-pathomic maps of glioblastoma identify phenotypes of non-enhancing tumor infiltration associated with bevacizumab treatment response
Background
Autopsy-based radio-pathomic maps of glioma pathology have shown substantial promise inidentifying areas of non-enhancing tumor presence, which may be able to differentiate subsets of patients that respond favorably to treatments such as bevacizumab that have shown mixed efficacy evidence. We tested the hypthesis that phenotypes of non-enhancing tumor fronts can distinguish between glioblastoma patients that will respond favorably to bevacizumab and will visually capture treatment response.
Methods
T1, T1C, FLAIR, and ADC images were used to generate radio-pathomic maps of tumor characteristics for 79 pre-treatment patients with a primary GBM or high-grade IDH1-mutant astrocytoma for this study. Novel phenotyping (hypercellular, hypocellular, hybrid, or well-circumscribed front) of the non-enhancing tumor front was performed on each case. Kaplan Meier analyses were then used to assess differences in survival and bevacizumab efficacy between phenotypes. Phenotype compartment segmentations generated longitudinally for a subset of 26 patients over the course of bevacizumab treatment, where a mixed effect model was used to detect longitudinal changes.
Results
Well-Circumscribed patients showed significant/trending increases in survival compared to Hypercellular Front (HR = 2.0,
p
= 0.05), Hypocellular Front (HR = 2.02,
p
= 0.03), and Hybrid Front tumors (HR = 1.75,
p
= 0.09). Only patients with hypocellular or hybrid fronts showed significant survival benefits from bevacizumab treatment (HR = 2.35,
p
= 0.02; and HR = 2.45,
p
= 0.03, respectively). Hypocellular volumes decreased by an average 50.52 mm
3
per day of bevacizumab treatment (
p
= 0.002).
Conclusion
Patients with a hypocellular tumor front identified by radio-pathomic maps showed improved treatment efficacy when treated with bevacizumab, and reducing hypocellular volumes over the course of treatment may indicate treatment response.
Journal Article
Complementary and alternative therapies for epilepsy
Annotation \"Epilepsy is a difficult illness to control: up to 35% of patients do not respond fully to traditional medical treatments. For this reason, many people with epilepsy choose to rely on or incorporate complementary and alternative medicine (CAM) into their treatment regimens. Written for physicians and other professionals, as well as for knowledgeable laypersons, Complementary and Alternative Therapies for Epilepsy bridges the worlds of traditional medicine and CAM to foster a broader perspective of healthcare for patients.\"--BOOK JACKET. Title Summary field provided by Blackwell North America, Inc. All Rights Reserved.
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