10018-COT-4 COMPARATIVE VOLUMETRIC ANALYSES FOLLOWING BEVACIZUMAB THERAPY FOR A PATIENT WITH CO- INCIDENCE OF GLIOBLASTOMA, MENINGIOM

Abstract

Abstract BACKGROUND Given that glioblastoma, meningioma and dural arteriovenous fistura (dAVF) represent angiogenic disease mainly caused by high expression of vascular endothelial growth factor (VEGF), bevacizumab is expected to be effective for these diseases. We experienced a patient with co-incidence of these 3 diseases was given neoadjuvant bevacizumab which provided a volume reduction of glioblastoma with improvement of clinical symptoms. CASE REPORT An eighty five year-old man has suffered from aphasia and dementia. Brain MRI showed a ring enhanced intraaxial tumor with perifocal edema in left temporal lobe, a dural-attached extraaxial tumor in the left sphenoid ridge and dAVF at left transverse-sigmoid sinus. Due to elderly with poor general condition, he was treated by administrate bevacizumab rather than the resection to confirm histological diagnosis. Three days after the administration, he began to walk and speech. RESULTS For comparison of the reactivity to bevacizumab among these three diseases, we calculated the volumetric quantitative assessment of glioblastoma and meningioma by the contrast-enhanced MRI and made a qualitative assesment for the dAVF by digital subtraction angiography (DSA) and MRA with comparison between before and afterbevacizumab administration. The volume reduction rates 1 and 5 months later after bevacizumab administration in glioblastoma and in meningioma were 0.34% and 94.5%, 13.7%, 6.8%, respectively. The volume reduction rate of glioblastoma was significantly larger than of Mg. The DSA showed the dAVF did not change even though bevacizumab therapy. DISCUSSION As previously reported, the VEGF concentration in the glioblastoma was significantly higher than that in other types of tumors including meningioma. In dAVF, other angiogenic factors would be produced in addition to VEGF. CONCLUSIONS Based on these evidences and the current rare case with co-incidence of glioblastoma, meningioma, and dAVF, it suggested that the effectiveness of bevacizumab therapy would be depend on the expression level of the VEGF concentration.