Incidence and outcome of pseudoprogression after radiation therapy in glioblastoma patients: a cohort study

IF 2.4 Q2 CLINICAL NEUROLOGY
Hanne Blakstad, Eduardo Erasmo Mendoza Mireles, Liv Cathrine Heggebø, Henriette Magelssen, Mette Sprauten, Tom Børge Johannesen, Einar Vik-Mo, Henning Leske, Pitt Niehusmann, Karoline Skogen, Eirik Helseth, Kyrre Eeg Emblem, Petter Brandal
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引用次数: 0

Abstract

Abstract Background Differentiating post-radiation MRI changes from progressive disease (PD) in glioblastoma (GBM) patients represents a major challenge. The clinical problem is two-sided; avoid termination of effective therapy in case of pseudoprogression (PsP) and continuation of ineffective therapy in case of PD. We retrospectively assessed incidence, management, and prognostic impact of PsP and analyzed factors associated with PsP in a GBM patient cohort. Methods Consecutive GBM patients diagnosed in South-Eastern Norway Health Region from 2015 to 2018 who had received RT and follow-up MRI were included. Tumor, patient, and treatment characteristics were analyzed in relationship to re-evaluated MRI examinations at three and six months post-radiation using Response Assessment in Neuro-Oncology criteria. Results A total of 284 patients were included in the study. PsP incidence three and six months post-radiation was 19.4% and 7.0%, respectively. In adjusted analyses, methylated O 6-methylguanine-DNA methyltransferase (MGMT) promoter and absence of neurological deterioration were associated with PsP at both three (p<0.001 and p=0.029, respectively) and six months (p=0.045 and p=0.034, respectively) post-radiation. For patients retrospectively assessed as PD three months post-radiation, there was no survival benefit of treatment change (p=0.838). Conclusion PsP incidence was similar to previous reports. In addition to the previously described correlation of methylated MGMT promoter with PsP, we also found that absence of neurological deterioration significantly correlated with PsP. Continuation of temozolomide courses did not seem to compromise survival for patients with PD at three months post-radiation; therefore, we recommend continuing adjuvant temozolomide courses in case of inconclusive MRI findings.
胶质母细胞瘤患者放射治疗后假性进展的发生率和结果:一项队列研究
背景:鉴别胶质母细胞瘤(GBM)患者放射后MRI变化与进展性疾病(PD)是一个重大挑战。临床问题是双面的;避免在假性进展(PsP)的情况下终止有效的治疗和在PD的情况下继续无效的治疗。我们回顾性地评估了一组GBM患者中PsP的发病率、治疗和预后影响,并分析了与PsP相关的因素。方法纳入2015 - 2018年挪威东南部卫生区诊断为GBM并接受RT和随访MRI的连续患者。肿瘤、患者和治疗特征分析与放疗后3个月和6个月的MRI检查的关系,使用神经肿瘤学标准中的反应评估。结果共纳入284例患者。放疗后3个月和6个月PsP发病率分别为19.4%和7.0%。在校正分析中,甲基化的O - 6-甲基鸟嘌呤- dna甲基转移酶(MGMT)启动子和没有神经退化与放射后3个月(p<0.001和p=0.029)和6个月(p=0.045和p=0.034)的PsP相关。对于放疗后3个月回顾性评估为PD的患者,治疗改变没有生存获益(p=0.838)。结论本组PsP发病率与既往报道相似。除了先前描述的甲基化MGMT启动子与PsP的相关性外,我们还发现神经退化的缺失与PsP显著相关。替莫唑胺疗程的延续似乎不会影响PD患者放疗后3个月的生存;因此,我们建议在MRI结果不确定的情况下继续使用替莫唑胺辅助疗程。
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来源期刊
Neuro-oncology practice
Neuro-oncology practice CLINICAL NEUROLOGY-
CiteScore
5.30
自引率
11.10%
发文量
92
期刊介绍: Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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