Early post-treatment pseudo-progression amongst glioblastoma multiforme patients treated with radiotherapy and temozolomide: A retrospective analysis

Gunjur, Ashray; Lau, Eddie; Taouk, Yamna; Ryan, Graeme B.

doi:10.1111/j.1754-9485.2011.02319.x

Cited by 43 publications

(40 citation statements)

References 22 publications

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“…Taal et al noted that 67% of the patients with ePD had accompanying neurologic deterioration, while only 33% of those with PsP had neurologic deterioration (p = 0.094 by Fisher's exact test) [30]. A similar trend was demonstrated in an Australian report [36], with apparent clinical progression accompanying radiographic findings ultimately deemed PsP in only three of 14 patients (21%), whereas 14 of 27 (52%) of those with ePD were symptomatic (p = 0.096). Brandes et al noted clinical deterioration in 21 out of 50 patients (42%) with enlarged imaging findings at 1 month post-chemoRT [46].…”

Section: Symptomssupporting

confidence: 76%

“…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%

“…As summarized in table 2, numerous studies [36,37,41,42] have demonstrated statistically significant differences in overall survival for patients experiencing PsP compared with ePD. Brandes et al, as described below, demonstrated that the patients with MGMT promoter methylation (a known positive prognostic factor) are more likely to demonstrate PsP than those without MGMT promoter methylation [46].…”

Section: Pseudoprogression As a Prognostic Indicatormentioning

confidence: 97%

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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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Section: Symptomssupporting

confidence: 76%

Section: Pseudoprogression With Radiation Plus Temozolomidementioning

confidence: 93%

Section: Pseudoprogression As a Prognostic Indicatormentioning

confidence: 97%

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Pseudoprogression after glioma therapy: a comprehensive review

Kruser

Mehta

Robins

2013

Expert Review of Neurotherapeutics

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“…First, several sources indicate that symptomatic patients and those with accompanied neurological deterioration are more likely to have early progressive disease rather than pseudoprogression. 3,13,19,33 In the senior author's (J.W.) experience, worsening or new-onset pain of nonmechanical quality in patients after spinal SRS may not be unusual, even in patients without progressive disease.…”

mentioning

confidence: 99%

“…3, 13,19,33 In the senior author's (J.W.) experience, worsening or new-onset pain of nonmechanical quality in patients after spinal SRS may not be unusual, even in patients without progressive disease.…”

mentioning

confidence: 99%

Tumor pseudoprogression of spinal metastasis after radiosurgery: a novel concept and case reports

Taylor

Weaver

2015

SPI

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Radiosurgery for primary and metastatic tumors of the central nervous system is increasing in utility and intensity. Known complications in the brain include radiation necrosis and the well-documented phenomenon of pseudoprogression. Known complications of radiosurgery to spinal column tumors include radiation myelopathy and delayed vertebral compression fractures; however, the concept of pseudoprogression of spinal column tumors has not been previously described. The authors review 2 cases of spinal metastasis treated with stereotactic radiosurgery (SRS) and attempt to define the concept of spine tumor pseudoprogression. Two patients who had undergone SRS to the spine for metastatic disease presented in early follow-up (3 and 7 weeks) with symptomatic complaints consisting of axial pain, radicular pain, or evidence of cord compression. In both patients, MRI revealed evidence of tumor enlargement. In one patient, the lesion had grown by 9 mm and 7.7 mm in the axial and sagittal planes, respectively. In the other patient, the tumor growth resulted in a 5-mm decrease in spinal canal diameter with epidural compression and right foraminal encroachment. Because of the absence of progressive neurological deficit, myelopathy, mechanical symptomatology of instability, or vertebral compression fracture, the first patient was treated expectantly with a corticosteroid taper and had improvement of symptoms at 1 month and near-total radiographic resolution of the tumor. In the second patient, worsening symptoms suggested a need for surgical intervention to address presumed radiosurgical failure and tumor progression. During surgery, only necrotic tumor cells were observed, without viable tumor. Follow-up imaging over 1 year showed ongoing local control. To their knowledge, the authors report the first description of pseudoprogression involving spinal column metastasis in the literature and aim to alert the treating physician to this clinical situation. Unlike brain tumor pseudoprogression, spine tumor pseudoprogression is a relatively early posttreatment phenomenon, measured in days to 2 months. The authors believe that the acute inflammatory response associated with tumor necrosis and disruption of the tumor capillary integrity caused by radiotherapy is an important component in the development of pseudoprogression. Future studies will be fundamental in assigning clinical significance, defining the incidence and predictors, and affecting future management of this phenomenon.

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Pseudoprogression as an adverse event of glioblastoma therapy

et al. 2017

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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.

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Early post-treatment pseudo-progression amongst glioblastoma multiforme patients treated with radiotherapy and temozolomide: A retrospective analysis

Cited by 43 publications

References 22 publications

Pseudoprogression after glioma therapy: a comprehensive review

Pseudoprogression after glioma therapy: a comprehensive review

Tumor pseudoprogression of spinal metastasis after radiosurgery: a novel concept and case reports

Pseudoprogression as an adverse event of glioblastoma therapy

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