Pseudoprogression as an adverse event of glioblastoma therapy

Abstract

We explored predictive factors of pseudoprogression (PsP) and its impact on prognosis in a retrospective series of uniformly treated glioblastoma patients. Patients were classified as having PsP, early progression (eP) or neither (nP). We examined potential associations with clinical, molecular, and basal imaging characteristics and compared overall survival (OS), progression‐free survival (PFS), post‐progression survival (PPS) as well as the relationship between PFS and PPS in the three groups. Of the 256 patients studied, 56 (21.9%) were classified as PsP, 70 (27.3%) as eP, and 130 (50.8%) as nP. Only MGMT methylation status was associated to PsP. MGMT methylated patients had a 3.5‐fold greater possibility of having PsP than eP (OR: 3.48; 95% CI: 1.606–7.564; P = 0.002). OS was longer for PsP than eP patients (18.9 vs. 12.3 months; P = 0.0001) but was similar for PsP and nP patients (P = 0.91). OS was shorter–though not significantly so—for PsP than nP patients (OS: 19.5 vs. 27.9 months; P = 0.63) in methylated patients. PPS was similar for patients having PsP, eP or nP (PPS: 7.2 vs. 5.4 vs. 6.7; P = 0.43). Neurological deterioration occurred in 64.3% of cases at the time they were classified as PsP and in 72.8% of cases of eP (P = 0.14). PsP confounds the evaluation of disease and does not confer a survival advantage in glioblastoma.

Dynamic Contrast-Enhanced MR Imaging of Nonenhancing T2 High-Signal-Intensity Lesions in Baseline and Posttreatment Glioblastoma: Temporal Change and Prognostic Value

“…For that reason, we could not evaluate pseudoprogression, which shows newly developed enhancing lesions during CCRT, but it might be related to favorable survival, though this is still controversial. 30,31 In addition, our results showed no statistical survival difference by the presence of the IDH mutation. It was possibly due to a small number of patients with IDH mutation with glioblastoma in our study population, which had insufficient statistical power.…”

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

“…Although radiographic findings of pseudoprogression may be difficult to distinguish from early progression of disease, as the patients were admitted to the acute care hospital with clinical deterioration, findings were thought to be related to progression/recurrence of disease. 22 Patients were excluded from the rGBM group if their neuroimaging did not reveal progression of disease or recurrence.…”

Pseudoprogression of brain tumors

“…The recently reported incidence of pseudoprogression varies widely, ranging from 9% to 30% . Importantly, it takes patients with clinical deterioration and pseudoprogression on average 7 months to recover .…”