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Population-based study of pseudoprogression after chemoradiotherapy in GBM.

Posted on: 10/17/2009

Can J Neurol Sci. 2009 Sep;36(5):617-22.
Population-based study of pseudoprogression after chemoradiotherapy in GBM.

Roldán GB, Scott JN, McIntyre JB, Dharmawardene M, de Robles PA, Magliocco AM, Yan ES, Parney IF, Forsyth PA, Cairncross JG, Hamilton MG, Easaw JC.

Department of Oncology, Tom Baker Cancer Centre, Alberta Cancer Board, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.

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.




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