Neuroimaging of Brain Tumors: Pseudoprogression, Pseudoresponse, and Delayed Effects of Chemotherapy and Radiation

Dietrich, Jörg; Winter, Sebastian; Klein, Joshua P.

doi:10.1055/s-0037-1608657

Cited by 19 publications

(5 citation statements)

References 55 publications

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“…On-target, antitumor response to radiation can be associated with tumor cell death, immune activation, and edema, leading to the phenomenon of pseudoprogression following radiotherapy. With respect to brain tumors, radiographic pseudoprogression is defined as increased contrast enhancement and other signs of tissue edema early following radiation therapy, which ultimately subsides without a change in disease directed therapy (88)(89)(90). The latter feature distinguishes pseudoprogression from true disease progression, which is inherently challenging to tease out on imaging analyses alone.…”

Section: Perspectives On Combining Targeted Therapies With Radiation -Safety and Toxicitymentioning

confidence: 99%

Radiation in Combination With Targeted Agents and Immunotherapies for Pediatric Central Nervous System Tumors - Progress, Opportunities, and Challenges

2021

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Pediatric brain tumors are the most common solid tumors in children and represent a heterogenous group of diagnoses. While some are treatable with current standard of care, relapsed/refractory disease is common and some high-risk diagnoses remain incurable. A growing number of therapy options are under development for treatment of CNS tumors, including targeted therapies that disrupt key tumor promoting processes and immunotherapies that promote anti-tumor immune function. While these therapies hold promise, it is likely that single agent treatments will not be sufficient for most high-risk patients and combination strategies will be necessary. Given the central role for radiotherapy for many pediatric CNS tumors, we review current strategies that combine radiation with targeted therapies or immunotherapies. To promote the ongoing development of rational combination treatments, we highlight 1) mechanistic connections between molecular drivers of tumorigenesis and radiation response, 2) ways in which molecular alterations in tumor cells shape the immune microenvironment, and 3) how radiotherapy affects the host immune system. In addition to discussing strategies to maximize efficacy, we review principles that inform safety of combination therapies.

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Section: Perspectives On Combining Targeted Therapies With Radiation -Safety and Toxicitymentioning

confidence: 99%

Radiation in Combination With Targeted Agents and Immunotherapies for Pediatric Central Nervous System Tumors - Progress, Opportunities, and Challenges

2021

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“…Brain atrophy was visually rated using the Global Cortical Atrophy Score, where 0 = none, 1 = mild, 2 = moderate, and 3 = severe atrophy [ 25 ]. Other signs of small-vessel disease such as perivascular spaces and cerebral microbleeds, as described in STRIVE v1 [ 13 , 26 , 27 ], were counted manually.…”

Section: Methodsmentioning

confidence: 99%

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

et al. 2023

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Purpose Radiotherapy (RT) is a recognized risk factor for cerebrovascular (CV) disease in children and in adults with head and neck cancer. We aimed to investigate whether cerebral RT increases the risk of CV disease in adults with primary brain tumors (PBT). Methods We retrospectively identified adults with a supratentorial PBT diagnosed between 1975 and 2006 and with at least 10 years follow-up after treatment. We analyzed demographic, clinical, and radiological features with special attention to CV events. We also described CV events, vascular risk factors, and intracranial artery modifications in a cross-sectional study of irradiated patients alive at the time of the study. Results A total of 116 patients, treated with RT (exposed group), and 85 non-irradiated patients (unexposed group) were enrolled. Stroke was more frequent in irradiated PBT patients than in the unexposed group (42/116 (36%) vs 7/85 (8%); p < 0.001), with higher prevalence of both ischemic (27/116 (23%) vs 6/85 (7%); p = 0.004) and hemorrhagic (12/116 (10%) vs 1/85 (1%); p = 0.02) stroke. In the irradiated group, patients with tumors near the Willis Polygon were more likely to experience stroke (p < 0.016). Fourty-four alive irradiated patients were included in the cross-sectional study. In this subgroup, intracranial arterial stenosis was more prevalent (11/45, 24%) compared to general population (9%). Conclusions Stroke prevalence is increased in long-surviving PBT patients treated with cranial RT. Implications for cancer survivors CV events are frequent in long survivors of PBT treated with cerebral RT. We propose a check list to guide management of late CV complications in adults treated with RT for PBT.

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“…However, distinguishing between tumor response, pseudoprogression, and progressive disease is a significant challenge in neuro-oncology patients treated with immunotherapy. Pseudoresponse is an alternative imaging pattern where the malignancy falsely appears to have responded to a particular therapy regimen 19, 20. Pseudoprogression has been commonly reported during immunotherapy in case reports or exploratory neuro-oncology studies 13, 14, while pseudoresponse during immunotherapy has not been widely documented in neuro-oncology patients.…”

Section: Review Of Response Criteria and Imaging Techniques Relevmentioning

confidence: 99%

Current and Future Imaging Methods for Evaluating Response to Immunotherapy in Neuro-Oncology

et al. 2019

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Imaging plays a central role in evaluating responses to therapy in neuro-oncology patients. The advancing clinical use of immunotherapies has demonstrated that treatment-related inflammatory responses mimic tumor growth via conventional imaging, thus spurring the development of new imaging approaches to adequately distinguish between pseudoprogression and progressive disease. To this end, an increasing number of advanced imaging techniques are being evaluated in preclinical and clinical studies. These novel molecular imaging approaches will serve to complement conventional response assessments during immunotherapy. The goal of these techniques is to provide definitive metrics of tumor response at earlier time points to inform treatment decisions, which has the potential to improve patient outcomes. This review summarizes the available immunotherapy regimens, clinical response criteria, current state-of-the-art imaging approaches, and groundbreaking strategies for future implementation to evaluate the anti-tumor and immune responses to immunotherapy in neuro-oncology applications.

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Neuroimaging of Brain Tumors: Pseudoprogression, Pseudoresponse, and Delayed Effects of Chemotherapy and Radiation

Cited by 19 publications

References 55 publications

Radiation in Combination With Targeted Agents and Immunotherapies for Pediatric Central Nervous System Tumors - Progress, Opportunities, and Challenges

Radiation in Combination With Targeted Agents and Immunotherapies for Pediatric Central Nervous System Tumors - Progress, Opportunities, and Challenges

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

Current and Future Imaging Methods for Evaluating Response to Immunotherapy in Neuro-Oncology

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