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Defining pseudoprogression in glioblastoma multiforme.

Al's Comment:

Pseudoprogression means that the MRI scan looks like there is progression when in reality it is not  progression. It was rare until we started using Temodar at the same time as radiation, now it occurs in about 12% of the people according to this article (I heard other numbers of about 50%). This article is the first time I saw mention that there is a major survival advantage when you see pseudoprogression - more than double the survival time compared to people who do not get pseudoprogression.


Posted on: 05/18/2013

Eur J Neurol. 2013 May 17. doi: 10.1111/ene.12192. [Epub ahead of print]
Defining pseudoprogression in glioblastoma multiforme.
Van Mieghem E, Wozniak A, Geussens Y, Menten J, De Vleeschouwer S, Van Calenbergh F, Sciot R, Van Gool S, Bechter OE, Demaerel P, Wilms G, Clement PM.
Leuven Cancer Institute, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
Pseudoprogression is a frequent phenomenon observed since the introduction of postoperative therapy with radiotherapy and temozolomide (RT/TMZ) in glioblastoma multiforme (GBM) patients. However, the criteria defining pseudoprogression, its incidence, the time of occurrence and its impact on therapy and outcome remain poorly defined.
The objective of this study is to compare two sets of criteria (liberal and stringent), defining pseudoprogression, in a cohort of patients treated before and after the introduction of RT/TMZ in the standard postoperative treatment. This retrospective review includes 136 unselected and consecutively treated patients with pathologically diagnosed GBM.
Pseudoprogression was observed in 10 (12%) cases applying the stringent criteria, and in 18 (23%) patients when using the liberal criteria, in the cohort treated with RT/TMZ. Pseudoprogression was observed in only one patient treated with RT alone. The median time to pseudoprogression was 4 weeks after the end of RT. Patients with pseudoprogression had a median survival time of 28 months, compared with 12 months for patients without pseudoprogression.
The incidence of pseudoprogression after RT/TMZ strongly depends on the applied criteria. However, regardless of the stringency of the criteria, the impact on survival remains the same.


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