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101. Gadolinium-enhanced magnetic resonance imaging of spinal tumours

Author

C. I. Rothwell, I M Holland, Tim Jaspan, and Brian S. Worthington

Subjects
Adult, Gadolinium DTPA, medicine.medical_specialty, Contrast enhancement, Adolescent, Gadolinium, Hemangiosarcoma, chemistry.chemical_element, Contrast Media, Astrocytoma, Spinal tumours, law.invention, Intramedullary rod, law, medicine, Organometallic Compounds, Humans, Radiology, Nuclear Medicine and imaging, Spinal Cord Neoplasms, Aged, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, Middle Aged, Pentetic Acid, Spinal cord, Magnetic Resonance Imaging, medicine.anatomical_structure, chemistry, Ependymoma, Radiology, business
Abstract

The use of gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) (Magnevist) enhanced magnetic resonance imaging (0.15 T) in the assessment of spinal tumours is described. Thirty-five patients were entered into the study and a total of 39 examinations were performed. The information obtained from unenhanced T1- and T2-weighted spin-echo sequences was compared with the Gd-DTPA-enhanced T1 images. Thirty patients had intradural lesions and five had extradural lesions. A variable pattern of enhancement of intramedullary tumours was found, which in part reflected differences in the cystic component of the lesions. Extramedullary intra- and extradural lesions generally showed marked enhancement. The greatest contribution to management decisions was in the evaluation of intramedullary tumours where the use of contrast enhancement facilitated the precise localization of active tumour, differentiation of cystic and solid components of tumour, separation of tumour from peritumoral oedema and, in cases of suspected recurrence, aided distinction between tumour and both post-operative scarring and radiation damage.

Published
1989

102. Phase II, Open-Label, Randomized, Multicenter Trial (HERBY) of Bevacizumab in Pediatric Patients With Newly Diagnosed High-Grade Glioma.

Author

Grill J, Massimino M, Bouffet E, Azizi AA, McCowage G, Cañete A, Saran F, Le Deley MC, Varlet P, Morgan PS, Jaspan T, Jones C, Giangaspero F, Smith H, Garcia J, Elze MC, Rousseau RF, Abrey L, Hargrave D, and Vassal G

Subjects
Adolescent, Antineoplastic Combined Chemotherapy Protocols adverse effects, Bevacizumab administration & dosage, Bevacizumab adverse effects, Cerebellar Neoplasms pathology, Cerebellar Neoplasms radiotherapy, Cerebellar Neoplasms surgery, Chemoradiotherapy, Adjuvant, Child, Child, Preschool, Female, Glioma pathology, Glioma radiotherapy, Glioma surgery, Humans, Male, Neoplasm Grading, Progression-Free Survival, Temozolomide administration & dosage, Temozolomide adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cerebellar Neoplasms drug therapy, Glioma drug therapy
Abstract

Purpose Bevacizumab (BEV) is approved in more than 60 countries for use in adults with recurrent glioblastoma. We evaluated the addition of BEV to radiotherapy plus temozolomide (RT+TMZ) in pediatric patients with newly diagnosed high-grade glioma (HGG). Methods The randomized, parallel group, multicenter, open-label HERBY trial ( ClinicalTrials.gov identifier: NCT01390948) enrolled patients age ≥ 3 years to ≤ 18 years with localized, centrally neuropathology-confirmed, nonbrainstem HGG. Eligible patients were randomly assigned to receive RT + TMZ (RT: 1.8 Gy, 5 days per week, and TMZ: 75 mg/m 2 per day for 6 weeks; 4-week treatment break; then up to 12 × 28-day cycles of TMZ [cycle 1: 150 mg/m 2 per day, days 1 to 5; cycles 2 to 12: 200 mg/m 2 per day, days 1 to 5]) with or without BEV (10 mg/kg every 2 weeks). The primary end point was event-free survival (EFS) as assessed by a central radiology review committee that was blinded to treatment. We report findings of EFS at 12 months after the enrollment of the last patient. Results One hundred twenty-one patients were enrolled (RT+TMZ [n = 59]; BEV plus RT+TMZ [n = 62]). Central radiology review committee-assessed median EFS did not differ significantly between treatment groups (RT+TMZ, 11.8 months; 95% CI, 7.9 to 16.4 months; BEV plus RT+TMZ, 8.2 months; 95% CI, 7.8 to 12.7 months; hazard ratio, 1.44; P = .13 [stratified log-rank test]). In the overall survival analysis, the addition of BEV did not reduce the risk of death (hazard ratio, 1.23; 95% CI, 0.72 to 2.09). More patients in the BEV plus RT+TMZ group versus the RT+TMZ group experienced one or more serious adverse events (n = 35 [58%] v n = 27 [48%]), and more patients who received BEV discontinued study treatment as a result of adverse events (n = 13 [22%] v n = 3 [5%]). Conclusion Adding BEV to RT+TMZ did not improve EFS in pediatric patients with newly diagnosed HGG. Our findings were not comparable to those of previous adult trials, which highlights the importance of performing pediatric-specific studies.

Published
2018
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