Pseudoprogression after radiation therapies for low grade glioma in children and adults: A systematic review and meta-analysis

Lu, Victor M.; Welby, John; Laack, Nadia N.; Mahajan, Anita; Daniels, David J.

doi:10.1016/j.radonc.2019.07.013

Cited by 25 publications

(17 citation statements)

References 41 publications

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“…In a recent systematic review, the incidence of PsP after PRT in pediatric LGG was estimated to be 34% (95% CI, 23-45%), and there was no statistically significant difference in the PsP incidence rate between modalities (P-heterogeneity = 0.96). For adult LGG, the incidence of PsP following PRT was significantly higher than that following IMRT (P-heterogeneity = 0.04) [45]. These results may be explained by the lack of data and the lack of standardized diagnostic criteria for PsP, resulting in an unknown degree of heterogeneity [16,46].…”

Section: Discussionmentioning

confidence: 99%

Proton Therapy and Gliomas: A Systematic Review

et al. 2021

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Background: Gliomas are primary cerebral tumors. Radiation therapy plays a key role in their treatment but with a risk of toxicity associated with the dose to and volume of normal tissue that is irradiated. With its precision properties allowing for the increased sparing of healthy tissue, proton therapy could be an interesting option for this pathology. Methods: Two reviewers performed a systematic review of original papers published between 2010 and July 2021 following PRISMA guidelines. We analyzed disease outcomes, toxicity outcomes, or dosimetry data in four separate groups: children/adults and individuals with low-/high-grade gliomas. Results: Among 15 studies, 11 concerned clinical and toxicity outcomes, and 4 reported dosimetry data. Proton therapy showed similar disease outcomes with greater tolerance than conventional radiation therapy, partly due to the better dosimetry plans. Conclusions: This review suggests that proton therapy is a promising technique for glioma treatment. However, studies with a high level of evidence are still needed to validate this finding.

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Section: Discussionmentioning

confidence: 99%

Proton Therapy and Gliomas: A Systematic Review

et al. 2021

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“…revealed that CIRT yields more beneficial and favorable long-term outcomes, i.e., fewer side effects or less metastasis and secondary cancers [ 416 , 456 ]. In particular, radioresistant tumor types such as glioblastoma, chondrosarcoma and head and neck cancers, non-small cell lung cancers, hepatocellular carcinoma, colorectal and gastrointestinal cancers, sinonasal malignancies, prostate and gynecological cancers have been successfully treated [ 456 , 477 , 478 , 492 , 493 , 494 , 495 , 496 , 497 , 498 , 499 , 500 ]. For that the radiation quality of C-ions matters a lot.…”

Section: Discussionmentioning

confidence: 99%

Role of Mitochondria in Radiation Responses: Epigenetic, Metabolic, and Signaling Impacts

Averbeck

Rodriguez-Lafrasse

2021

IJMS

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Until recently, radiation effects have been considered to be mainly due to nuclear DNA damage and their management by repair mechanisms. However, molecular biology studies reveal that the outcomes of exposures to ionizing radiation (IR) highly depend on activation and regulation through other molecular components of organelles that determine cell survival and proliferation capacities. As typical epigenetic-regulated organelles and central power stations of cells, mitochondria play an important pivotal role in those responses. They direct cellular metabolism, energy supply and homeostasis as well as radiation-induced signaling, cell death, and immunological responses. This review is focused on how energy, dose and quality of IR affect mitochondria-dependent epigenetic and functional control at the cellular and tissue level. Low-dose radiation effects on mitochondria appear to be associated with epigenetic and non-targeted effects involved in genomic instability and adaptive responses, whereas high-dose radiation effects (>1 Gy) concern therapeutic effects of radiation and long-term outcomes involving mitochondria-mediated innate and adaptive immune responses. Both effects depend on radiation quality. For example, the increased efficacy of high linear energy transfer particle radiotherapy, e.g., C-ion radiotherapy, relies on the reduction of anastasis, enhanced mitochondria-mediated apoptosis and immunogenic (antitumor) responses.

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“…Therapy regimes preceding the DSC-MRI examination (radiotherapy, chemotherapy, or immunotherapy within the previous two years) were also noted. The individual outcome for both high grade and low grade glioma was defined in accordance with the RANO [5] and if applicable, the iRANO [6] criteria [18][19][20]. For the definition of PD and PsP in these patients, clinical data and histopathology (as available) were used as reference standards by retrieving the patients' electronic health records within 6-9 months from the time of the analyzed MRI.…”

Section: Patientsmentioning

confidence: 99%

Dynamic Susceptibility Perfusion Imaging for Differentiating Progressive Disease from Pseudoprogression in Diffuse Glioma Molecular Subtypes

Richter

Klose

Bender

et al. 2021

JCM

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Rationale and Objectives: Advanced adjuvant therapy of diffuse gliomas can result in equivocal findings in follow-up imaging. We aimed to assess the additional value of dynamic susceptibility perfusion imaging in the differentiation of progressive disease (PD) from pseudoprogression (PsP) in different molecular glioma subtypes. Materials and Methods: 89 patients with treated diffuse glioma with different molecular subtypes (IDH wild type (Astro-IDHwt), IDH mutant astrocytomas (Astro-IDHmut) and oligodendrogliomas), and tumor-suspect lesions on post-treatment follow-up imaging were classified into two outcome groups (PD or PsP) retrospectively by histopathology or clinical follow-up. The relative cerebral blood volume (rCBV) was assessed in the tumor-suspect FLAIR and contrast-enhancing (CE) lesions. We analyzed how a multilevel classification using a molecular subtype, the presence of a CE lesion, and two rCBV histogram parameters performed for PD prediction compared with a decision tree model (DTM) using additional rCBV parameters. Results: The PD rate was 69% in the whole cohort, 86% in Astro-IDHwt, 52% in Astro-IDHmut, and 55% in oligodendrogliomas. In the presence of a CE lesion, the PD rate was higher with 82%, 94%, 59%, and 88%, respectively; if there was no CE lesion, however, the PD rate was only 44%, 60%, 40%, and 33%, respectively. The additional use of the rCBV parameters in the DTM yielded a prediction accuracy for PD of 99%, 100%, 93%, and 95%, respectively. Conclusion: Utilizing combined information about the molecular tumor type, the presence or absence of CE lesions and rCBV parameters increases PD prediction accuracy in diffuse glioma.

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Pseudoprogression after radiation therapies for low grade glioma in children and adults: A systematic review and meta-analysis

Cited by 25 publications

References 41 publications

Proton Therapy and Gliomas: A Systematic Review

Proton Therapy and Gliomas: A Systematic Review

Role of Mitochondria in Radiation Responses: Epigenetic, Metabolic, and Signaling Impacts

Dynamic Susceptibility Perfusion Imaging for Differentiating Progressive Disease from Pseudoprogression in Diffuse Glioma Molecular Subtypes

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