Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Topkan, Erkan; Topuk, Savaş; Oymak, Ezgi; Parlak, Eda; Pehlivan, Berrin

doi:10.1097/coc.0b013e318210f54a

Cited by 51 publications

(53 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The surgery for suspected recurrence occurred at a median of 9.3 months after the initial diagnosis. The median survival from surgery for suspected recurrence and from initial diagnosis was 8 [5–14] and 20 [12–30] months, respectively. Following pathological review, 17 patients (29, 95 % CI 18–42 %) had a diagnosis of “no active high-grade tumor”.…”

Section: Resultsmentioning

confidence: 99%

“…tumor progression that had received standard chemo-radiation therapy, who were re-operated for histopathological confirmation. They found that 19 % of these patients had pseudoprogression and that this pathologic diagnosis corresponded with improved survival using non-controlled, log-rank analysis [12]. The authors mention morphologic characterization, however they did not offer clear histopathological criteria for the diagnosis of pseudoprogression.…”

Section: Discussionmentioning

confidence: 99%

“…Histopathological analysis remains the diagnostic standard for guiding clinical decision-making and further treatments. The few studies that have included histopathological analysis have not clearly defined the pathologic criteria for distinguishing treatment effects from active neoplasm and, as a result, observed a broad range (6–19 %) of lesions diagnosed as pseudoprogression at the time of re-operation [3, 11, 12]. Currently, the advantage of pathologic diagnosis of the latter is debated, and histopathological requirements for active tumor versus treatment effect are undefined.…”

Section: Introductionmentioning

confidence: 99%

“…Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5–14] and 20 [12–30] months. Seventeen patients (29 %) had no evidence of active high-grade tumor and 42 (71 %) had at least focal active high-grade glioma.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Histopathological correlates with survival in reoperated glioblastomas

Woodworth

Garzón-Muvdi

et al. 2013

J Neurooncol

View full text Add to dashboard Cite

The addition of concomitant and adjuvant chemotherapy to radiation therapy after surgical resection has increased significantly the survival of patients with glioblastoma (GB). In conjunction, there has been an increasing fraction of patients who present with new enlarged areas of contrast enhancement and edema on post-treatment imaging that improve without further treatment. It remains to be established how this phenomenon, commonly termed pseudoprogression, can be distinguished from true tumor recurrence defined as the histological presence of active high-grade tumor, as well as its prognostic significance. Data for over 500 patients undergoing surgery for recurrent GB were reviewed. Pathological specimens were categorized as those that contained active high-grade glioma in any amount, and those that did not. Patient survival was compared between these two groups, and independent associations were assessed using Cox proportionate hazards regression analysis. 59 patients met the study criteria including complete pathological and follow-up data. Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5–14] and 20 [12–30] months. Seventeen patients (29 %) had no evidence of active high-grade tumor and 42 (71 %) had at least focal active high-grade glioma. Pathologic pseudoprogression at re-operation (p = 0.03) and gross total resection (p = 0.01) were independently associated with survival. The histopathological features defined here and used to assess the tumor at reoperation were independently associated with survival. These findings may be important in designing treatment strategies and clinical trial endpoints for patients with GB.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Histopathological correlates with survival in reoperated glioblastomas

Woodworth

Garzón-Muvdi

et al. 2013

J Neurooncol

View full text Add to dashboard Cite

show abstract

“…1,2 However, the appearance of enhancing lesions on MR imaging within the first 6 months after completion of chemoradiation therapy poses a challenge because it can reflect true progression (TP) or treatment-related changes known as pseudoprogression (PsP). PsP occurs in approximately a third of all patients with glioblastoma, 3 in which lesions often decrease in size or stabilize without further treatment, resulting in a longer survival. Accurate identifica-tion of PsP and TP is critical because patients with TP may require a change in therapeutic strategy while those with PsP may not.…”

mentioning

confidence: 99%

Differentiating Tumor Progression from Pseudoprogression in Patients with Glioblastomas Using Diffusion Tensor Imaging and Dynamic Susceptibility Contrast MRI

Wang¹,

Martinez‐Lage²,

Sakai³

et al. 2015

AJNR Am J Neuroradiol

133

113

View full text Add to dashboard Cite

show abstract

Pseudoprogression of brain tumors

Thust

Bent

Smits

2018

Magnetic Resonance Imaging

237

194

View full text Add to dashboard Cite

This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high‐grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day‐to‐day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9–30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow‐up. The combination of MRS and diffusion‐weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer‐aided diagnostic technology, and meticulous evaluation with clinical and pathological data. Level of Evidence: 3 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;48:571–589.

show abstract

Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Cited by 51 publications

References 22 publications

Histopathological correlates with survival in reoperated glioblastomas

Histopathological correlates with survival in reoperated glioblastomas

Differentiating Tumor Progression from Pseudoprogression in Patients with Glioblastomas Using Diffusion Tensor Imaging and Dynamic Susceptibility Contrast MRI

Pseudoprogression of brain tumors

Contact Info

Product

Resources

About