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Calcification in high grade gliomas treated with bevacizumab

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Abstract

Calcification is a rare phenomenon in high grade glioma (HGG). CT scans are sensitive to mineralization but used infrequently for tumor assessment in the MRI era. The presence of calcification can be overlooked on routine MRI. Calcification may reflect chronicity and natural changes in the tumor or its milieu over time and may be accelerated by certain treatments. Calcification may have clinical significance which could signal potential risk for stroke or hemorrhage related to particular therapies; or it may be a positive prognostic factor for treatment response. The true incidence and relevance of calcification in HGG and relation to therapy is unclear. During treatment of HGG patients with bevacizumab (BVZ) we observed significant tumor calcification on brain CT. We performed a retrospective review of HGG patients treated with BVZ to quantitate the incidence of calcification in this group compared to those treated with cytotoxic therapy alone. Sixty-two patients with progressive HGG were treated with BVZ and a cytotoxic agent. Among 19 patients treated for 6+ months, 12 had a CT scan performed. We observed an unexpected phenomenon of calcification in the CT scans of several patients. We were also able to comparatively quantitate the incidence of calcification in a control group of primary glioblastoma (GB) patients not exposed to BVZ therapy. The incidence of calcification in the general GB population is increased with longer survival. The phenomenon is increased with anti-angiogenic therapy for brain tumors. Calcification may have significance as a predictor for treatment response.

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Conflict of interest

We declare that there is no conflict of interest for any of the authors.

Funding

We declare that there was no outside funding that supported this research.

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Authors and Affiliations

  1. Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel

    Deborah T. Blumenthal, Idan Ben-Horin & Felix Bokstein

  2. Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel

    Orna Aisenstein, Dafna Ben Bashat & Moran Artzi

  3. Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 69978, Tel Aviv, Israel

    Dafna Ben Bashat, Moran Artzi & Benjamin W. Corn

  4. Institute of Radiotherapy, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel

    Benjamin W. Corn

  5. Department of Neurosurgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel

    Andrew A. Kanner & Zvi Ram

Authors
  1. Deborah T. Blumenthal
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  2. Orna Aisenstein
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  3. Idan Ben-Horin
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  4. Dafna Ben Bashat
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  5. Moran Artzi
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  6. Benjamin W. Corn
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  7. Andrew A. Kanner
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  8. Zvi Ram
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  9. Felix Bokstein
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Corresponding author

Correspondence to Deborah T. Blumenthal.

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Blumenthal, D.T., Aisenstein, O., Ben-Horin, I. et al. Calcification in high grade gliomas treated with bevacizumab. J Neurooncol 123, 283–288 (2015). https://doi.org/10.1007/s11060-015-1796-z

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  • DOI: https://doi.org/10.1007/s11060-015-1796-z

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