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54 The median OS after tumor progression on bevacizumab was 4.5 months, with a pattern of progression characterized by an increase in enhancement at the original site of tumor (46%), a new enhancing lesion distant to the original tumor location (16%), and growth of nonenhancing tumor (35%).
As previously reported, new, enhancing MRI lesions were noted in four patients all within 13 months of treatment.
In our case the availability of prior CT imaging demonstrating a fat-containing adnexal mass with areas of calcification and a subsequent CT that demonstrated interval enlargement with a new, enhancing soft tissue component was concerning for malignant transformation of the MCT.
Furthermore, early appearance of new enhancing lesions within 6 months was also a significant independent variable for tumor progression (p < 0.001 by log-rank test).
The treated group showed significantly fewer new active nuclear MRI (NMR) lesions and fewer new enhancing lesions than the placebo group.
However, a new clinical event or serial imaging to show a new enhancing or T2 lesion will still be required to establish DIT in those patients who do not have both gadolinium-enhancing and nonenhancing lesions on their baseline MRI.
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