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Kebir, Sied; Schaub, Christina; Junold, Nina; Hattingen, Elke; Schäfer, Niklas; Steinbach, Joachim P.; Weyerbrock, Astrid; Hau, Peter; Goldbrunner, Roland; Galldiks, Norbert; Weller, Johannes; Mack, Frederic; Tzaridis, Theophilos; Baehr, Oliver; Seidel, Clemens; Schlegel, Uwe; Schmidt-Graf, Friederike; Rohde, Veit; Borchers, Christian; Tabatabai, Ghazaleh; Haenel, Mathias; Sabel, Michael; Gerlach, Rüdiger; Krex, Dietmar; Belka, Claus; Vatter, Hartmut; Proescholdt, Martin; Glas, Martin and Herrlinger, Ulrich (2019): Baseline T1 hyperintense and diffusion-restricted lesions are not linked to prolonged survival in bevacizumab-treated glioblastoma patients of the GLARIUS trial. In: Journal of Neuro-Oncology, Vol. 144, No. 3: pp. 501-509

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Purpose The phase II GLARIUS trial assigned patients with newly diagnosed, O-6-methylguanine-DNA methyltransferase promoter non-methylated glioblastoma to experimental bevacizumab/irinotecan (BEV/IRI) or standard temozolomide (TMZ). To identify subpopulations with a particularly favorable course, we assessed the prognostic potential of magnetic resonance imaging (MRI) markers before treatment onset. Methods MRIs at baseline (before treatment onset) were analyzed for T1-hyperintense and diffusion-restricted lesions;as well as the presence of both hyperintense and diffusion-restricted (double positive) lesions. The MRI findings were correlated with overall and progression-free survival. Results MRI scans were evaluable in 71% of the GLARIUS modified intention-to-treat population (n = 121 of 170;88 patients in the BEV/IRI arm, and 33 patients in the TMZ control arm). Diffusion-restricted and T1 hyperintense lesions were present in 60% and 65% of patients in BEV/IRI arm, while 57% and 63% were found in the TMZ arm, respectively. Double positive lesions were found in 37% of BEV/IRI patients and in 39% of TMZ patients. Neither the presence of T1-hyperintense, diffusion-restricted lesions, nor double positive lesions were associated with improved survival. Conclusions Baseline T1-hyperintense and diffusion-restricted lesions are not suitable to predict progression-free or overall survival of patients treated with bevacizumab/irinotecan or temozolomide.

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