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Population-Based Study of Pseudoprogression after Chemoradiotherapy in GBM

Published online by Cambridge University Press:  02 December 2014

Gloria B. Roldán
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary
James N. Scott
Affiliation:
Department of Diagnostic Imaging, University of Calgary
John B. McIntyre
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Pathology & Lab Medicine, University of Calgary
Marisa Dharmawardene
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board
Paula A. de Robles
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary
Anthony M. Magliocco
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Pathology & Lab Medicine, University of Calgary
Elizabeth S. Y. Yan
Affiliation:
Department of Radiation Oncology, Mayo Clinic, Rochester MN, USA
Ian F. Parney
Affiliation:
Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
Peter A. Forsyth
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Heritage Medical Research Building, Calgary, AB, Canada
J. Gregory Cairncross
Affiliation:
Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Heritage Medical Research Building, Calgary, AB, Canada
Mark G. Hamilton
Affiliation:
Department of Clinical Neurosciences, University of Calgary Clark Smith Integrated Brain Tumor Research Centre, Heritage Medical Research Building, Calgary, AB, Canada
Jacob C. Easaw
Affiliation:
Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board Clark Smith Integrated Brain Tumor Research Centre, Heritage Medical Research Building, Calgary, AB, Canada
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Abstract

Introduction:

Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression.

Methods:

We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status.

Results:

Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression.

Conclusions:

These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

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