Differentiating pseudoprogression from true progression: analysis of radiographic, biologic, and clinical clues in GBM.

Journal of Neuro-oncology
Lindsay S RoweAndra V Krauze

Abstract

Pseudoprogression (PsP) is a diagnostic dilemma in glioblastoma (GBM) after chemoradiotherapy (CRT). Magnetic resonance imaging (MRI) features may fail to distinguish PsP from early true progression (eTP), however clinical findings may aid in their distinction. Sixty-seven patients received CRT for GBM between 2003 and 2016, and had pre- and post-treatment imaging suitable for retrospective evaluation using RANO criteria. Patients with signs of progression within the first 12-weeks post-radiation (P-12) were selected. Lesions that improved or stabilized were defined as PsP, and lesions that progressed were defined as eTP. The median follow up for all patients was 17.6 months. Signs of progression developed in 35/67 (52.2%) patients within P-12. Of these, 20/35 (57.1%) were subsequently defined as eTP and 15/35 (42.9%) as PsP. MRI demonstrated increased contrast enhancement in 84.2% of eTP and 100% of PsP, and elevated CBV in 73.7% for eTP and 93.3% for PsP. A decrease in FLAIR was not seen in eTP patients, but was seen in 26.7% PsP patients. Patients with eTP were significantly more likely to require increased steroid doses or suffer clinical decline than PsP patients (OR 4.89, 95% CI 1.003-19.27; p = 0.046). KPS declined in 25...Continue Reading

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Citations

Sep 24, 2019·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Renata BelanovaTomas Kazda
Jun 6, 2019·Frontiers in Oncology·Ahmad ChaddadBassam Abdulkarim
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May 1, 2021·International Journal of Molecular Sciences·Sanjeev ChawlaHarish Poptani
Sep 18, 2021·Current Opinion in Oncology·Lucia Nichelli, Stefano Casagranda

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