Pseudoprogression Following Chemoradiotherapy for Glioblastoma Multiforme

Sanghera, Paul; Perry, James; Sahgal, Arjun; Symons, Sean; Aviv, Richard I.; Morrison, M.; Lam, Kelvin; Davey, Phillip; Tsao, May

doi:10.1017/s0317167100009628

Cited by 105 publications

(77 citation statements)

References 23 publications

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“…The 50% rate of pseudo progression in our study (5 of 10) is comparable to those studies. (Roldan et al, 2009;Sanghera et al, 2010). In this study, the median overall survival (OS) and progression free survival (PFS) of 16 and 6 months are comparable to the EORTC results showing a median OS and PFS of 14.9 and 6.9 months.…”

Section: Discussionsupporting

confidence: 78%

Efficacy of High Dose Radiotherapy in Post-operative Treatment of Glioblastoma Multiform - A Single Institution Report

Pashaki

Hamed²,

Mohamadian³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Discussionsupporting

confidence: 78%

Efficacy of High Dose Radiotherapy in Post-operative Treatment of Glioblastoma Multiform - A Single Institution Report

Pashaki

Hamed²,

Mohamadian³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…The differentiation of a recurrent/progressive tumor from radiation injury is often a clinical dilemma, given that pseudoprogression may influence decisions to continue adjuvant chemotherapy rather than changing to a second-line therapy for recurrent disease [2][3][4][5][6][7]17]. If a post-chemoradiotherapy follow-up MRI examination demonstrates complete or partial response or stable disease (i.e., smaller or stable tumor enhancement), maintenance of chemotherapy is typically continued.…”

Section: Discussionmentioning

confidence: 99%

Single dose bevacizumab as treatment for symptomatic, corticosteroid-refractory pseudoprogression after chemoradiation therapy for newly diagnosed glioblastoma: A case report

Morris¹,

Vallières²,

Attwell³

et al. 2015

Integr Cancer Sci Therap

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The survival of patients with glioblastoma has improved significantly since the introduction of radiation therapy with concurrent and adjuvant temolozolomide as standard therapy. However, symptomatic increases in MRI enhancement and edema mimicking tumor progression (pseudoprogression) have been well described after dual modality chemoradiation. We report the outcome of a glioblastoma patient after the administration of a single dose of bevacizumab for corticosteroidrefractory pseudoprogression. A 60-year old male with an unresectable glioblastoma developed symptoms and MRI changes suggestive of either progression or pseudoprogression during cycle one of adjuvant temozolomide, six weeks after completing treatment with radiation therapy and concomitant temozolomide. The patient's condition's did not respond adequately to high doses of corticosteroids but improved rapidly after a single dose of bevacizumab. MRI taken two weeks after the administration of bevacizumab showed significant improvement. The patient received no further therapy or corticosteroids. Follow-up MRI three months later showed no evidence of progression. We report the case of a glioblastoma patient suspected of developing pseudoprogression after combined modality chemoradiation. The dramatic symptomatic improvement after a single dose of bevacizumab suggests that a short course of the drug may be an effective strategy for the treatment of pseudoprogression in patients who respond poorly to corticosteroids.

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“…Tumour recurrence should be assessed according to the rano criteria 19 (grade of recommendation: A). Progression observed by mri after chemoradiation can be pseudo-progression in 20%-50% of cases, particularly in patients treated with concurrent radiation and temozolomide [22][23][24] .…”

Section: Pseudo-progressionmentioning

confidence: 99%

“…A recent Canadian study examined pseudoprogression in 104 evaluable glioblastoma patients 24 . Pseudo-progression was defined as early progression, with disease stabilization in the absence of salvage therapy for at least 6 months after completion of chemoradiotherapy with temozolomide.…”

Section: Pseudo-progressionmentioning

confidence: 99%

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

Easaw¹,

Mason²,

Perry³

et al. 2011

Current Oncology

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Recommendation 1: Multidisciplinary Approach: To optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions. Recommendation 2: Imaging: The standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (MRI). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of MRI after chemoradiation and adjunctive therapy have not been established. Recommendation 3: Pseudo-progression: Progression observed by MRI after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing MRI within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained. Recommendation 4: Repeat Surgery: Surgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient’s quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient. Recommendation 5: Re-irradiation: Re-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma. Recommendation 6: Systemic Therapy: Clinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or antiangiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.

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Pseudoprogression Following Chemoradiotherapy for Glioblastoma Multiforme

Cited by 105 publications

References 23 publications

Efficacy of High Dose Radiotherapy in Post-operative Treatment of Glioblastoma Multiform - A Single Institution Report

Efficacy of High Dose Radiotherapy in Post-operative Treatment of Glioblastoma Multiform - A Single Institution Report

Single dose bevacizumab as treatment for symptomatic, corticosteroid-refractory pseudoprogression after chemoradiation therapy for newly diagnosed glioblastoma: A case report

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

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