Radiation induced early necrosis in patients with malignant gliomas receiving temozolomide

Yaman, Emel; Büyükberber, Süleyman; Benekli, Mustafa; Oner, Yusuf; Coşkun, Uğur; Akmansu, Müge; Öztürk, Bayram; Kaya, Ali; Uncu, Doğan; Yıldız, Ramazan

doi:10.1016/j.clineuro.2010.05.003

Cited by 29 publications

(24 citation statements)

References 19 publications

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“…[4][5][6][7][8][9][10][11][12] In our present study, majority of the cases with pseudoprogression (58.3%) were diagnosed at first 2 months of post-TMZ/RT period with a median of 2.9 months which is in good agreement with existing literature. In a similarly designed study, after concurrent TMZ and RT, Chamberlain et al 4 reported surgically confirmed pseudoprogression in 7 of 51 (14%) patients with malignant glioma, and all were presented within 6 months after completion of treatment which is very similar with current findings presented here.…”

Section: Discussionsupporting

confidence: 93%

“…However, results of salvage surgery studies, those limited to first 6 months of postchemoradiotherapy period, showed a high incidence of pathologically confirmed pseudoprogression rather than true tumor progression. [4][5][6][7][8][9][10][11][12] Incidence of radiologic doubt of tumor progression was 44.4% in our present study, however, despite the fact that all these 28 patients had underwent salvage surgery, pathologic results confirmed true progression only in 57.2% them. Remaining 42.8%, which corresponds to 19% of overall study population, showed pathologic findings associated with treatment-related necrosis without viable tumor cells and therefore judged to have pseudoprogression.…”

Section: Discussioncontrasting

confidence: 76%

“…However, this monitoring has also led to an increased awareness that many patients with early findings of neuroradiologic progressive lesion(s) after treatment do not suffer from true tumor progression. [4][5][6][7][8][9][10][11][12] In this setting, accompanying progressive clinical signs and symptoms may also mimic tumor progression in some patients and further support the misdiagnosis of true progression. However, results of salvage surgery studies, those limited to first 6 months of postchemoradiotherapy period, showed a high incidence of pathologically confirmed pseudoprogression rather than true tumor progression.…”

Section: Discussionmentioning

confidence: 93%

“…3 Although these cornerstone criteria serve as a useful tool for routine practice, results of recent clinical trials suggest strong doubts on potential biasing effects of TMZ as radiosensitizer and RT combination on the radiologic evaluation of disease progression. [4][5][6][7][8][9][10][11][12] The treatment-related changes in cell structure and metabolism created with this combination can lead to disruption of blood-brain barrier with the resultant observation of an early radiologic increase in contrast enhancement at magnetic resonance imaging (MRI), which may falsely mimic true progression. [13][14][15][16] This phenomenon, which is indistinguishable from true tumor progression, was first described by Hoffman et al 17 in a group of malignant glioma patients treated with RT and carmustine, and is currently labeled to pseudoprogression.…”

mentioning

confidence: 98%

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Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Topkan

Topuk²,

Oymak³

et al. 2012

American Journal of Clinical Oncology

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Current results indicates the urgency of need for novel imaging techniques and/or biochemical marker(s) that can better distinguish pseudoprogression from true progression to avoid unnecessary and potentially harmful surgical interventions in almost half of the radiologically progressive GBM patients. Our additional observation which suggests better survival for patients with pseudoprogression warrants to be studied in larger patient cohorts.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 98%

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Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Topkan

Topuk²,

Oymak³

et al. 2012

American Journal of Clinical Oncology

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“…As clinical awareness of PsP has risen, a large body of literature has helped to further define the incidence and factors associated with PsP in the setting of RT plus TMZ for HGG [11,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. These observed rates of early progression and PsP noted in these studies are summarized in table 1.…”

Section: Pseudoprogression With Radiation Plus Temozolomidementioning

confidence: 93%

Pseudoprogression after glioma therapy: a comprehensive review

Kruser

Mehta

Robins

2013

Expert Review of Neurotherapeutics

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Over the last decade, pseudoprogression as a clinically significant entity affecting both glioma patient management and the conduct of clinical trials has been recognized as a significant issue. The authors have summarized the literature relative to the incidence, chronological sequence, therapy-relatedness, impact of O-6-methylguanine-DNA methyltransferase methylation status and clinical features of pseudoprogression. Evidence regarding numerous neuroradiologic techniques to differentiate pseudoprogression from tumor recurrence is summarized. The implications of pseudoprogression on prognosis and clinical trial design are substantial, and are reviewed. Relative to this, the overlapping terms pseudoprogression and radiation necrosis are clarified to produce an appropriate basis for future consideration and research regarding this important biological phenomenon.

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Liquid Biopsy Strategies to Distinguish Progression from Pseudoprogression and Radiation Necrosis in Glioblastomas

et al. 2020

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despite aggressive treatment. [1] Currently, maximal resection followed by radiation therapy with concurrent temozolomide (TMZ) and adjuvant TMZ treatment is the standard of care. Post-treatment surveillance involves serial MRI. A challenge faced by clinicians is the diagnosis and management of a gadolinium enhancing lesion on a follow-up MRI post-treatment. This suspicious lesion could be progressive disease (PD) or a mere post-treatment radiation effects such as pseudoprogression or radiation necrosis (RN). Pseudoprogression and RN are distinct clinical entities, which when identified and managed appropriately result in better outcomes, while PD of the tumor is often dismal. Patients with PD have a median survival of 3-6 months, [2] and there is no standard of care. Systemic options include TMZ rechallenge, lomustine, and antiangiogenic therapy such as bevacizumab, but their effectiveness is limited. Reradiation and reresection can be considered depending on the location of the tumor and the condition of the patient. [3] Conversely, antiangiogenic drugs like bevacizumab or cediranib decrease contrast enhancement by altering permeability of tumor vasculature without actual reduction in tumor burden, referred to as pseudoresponse. Distinguishing these clinical entities from PD is crucial to avoid unnecessary reoperations, premature discontinuation of adjuvant TMZ or its substitution with second line agents. MR imaging based monitoring is the current standard of care for post-surgical monitoring. Contrast enhancement on imaging is indicative of disrupted blood brain barrier (BBB), but not tumor presence. [4] Currently, MRI-based Response Assessment in Neuro-Oncology (RANO) criteria is used to monitor treatment response in GBM patients. The criteria included T1 gadolinium enhancing disease, T2/FLAIR changes, new lesions, corticosteroid use, and clinical status. [5] Adoption of RANO criteria for monitoring response is not without limitations. There is ambiguity in identifying radiation effects, enrolling patients into clinical trials and monitoring immunotherapy response. [6] Advanced imaging modalities including diffusion-tensor imaging, perfusion imaging, MR spectroscopy (MRS), and positron emission tomography (PET) imaging Liquid biopsy for the detection and monitoring of central nervous system tumors is of significant clinical interest. At initial diagnosis, the majority of patients with central nervous system tumors undergo magnetic resonance imaging (MRI), followed by invasive brain biopsy to determine the molecular diagnosis of the WHO 2016 classification paradigm. Despite the importance of MRI for long-term treatment monitoring, in the majority of patients who receive chemoradiation therapy for glioblastoma, it can be challenging to distinguish between radiation treatment effects including pseudoprogression, radiation necrosis, and recurrent/progressive disease based on imaging alone. Tissue biopsy-based monitoring is high risk and not always feasible. However, distinguishing these entities is of critical im...

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Radiation induced early necrosis in patients with malignant gliomas receiving temozolomide

Cited by 29 publications

References 19 publications

Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Pseudoprogression in Patients With Glioblastoma Multiforme After Concurrent Radiotherapy and Temozolomide

Pseudoprogression after glioma therapy: a comprehensive review

Liquid Biopsy Strategies to Distinguish Progression from Pseudoprogression and Radiation Necrosis in Glioblastomas

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