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Hilario A, Salvador E, Cardenas A, Romero J, Lechuga C, Chen Z, Martinez de Aragon A, Perez-Nuñez A, Hernandez-Lain A, Sepulveda J, Lagares A, Toldos O, Rodriguez-Gonzalez V, Ramos A. Low rCBV values in glioblastoma tumor progression under chemoradiotherapy. Neuroradiology 2024; 66:317-323. [PMID: 38183424 DOI: 10.1007/s00234-023-03279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/26/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE After standard treatment for glioblastoma, perfusion MRI remains challenging for differentiating tumor progression from post-treatment changes. Our objectives were (1) to correlate rCBV values at diagnosis and at first tumor progression and (2) to analyze the relationship of rCBV values at tumor recurrence with enhancing volume, localization of tumor progression, and time elapsed since the end of radiotherapy in tumor recurrence. METHODS Inclusion criteria were (1) age > 18 years, (2) histologically confirmed glioblastoma treated with STUPP regimen, and (3) tumor progression according to RANO criteria > 12 weeks after radiotherapy. Co-registration of segmented enhancing tumor VOIs with dynamic susceptibility contrast perfusion MRI was performed using Olea Sphere software. For tumor recurrence, we correlated rCBV values with enhancing tumor volume, with recurrence localization, and with time elapsed from the end of radiotherapy to progression. Analyses were performed with SPSS software. RESULTS Sixty-four patients with glioblastoma were included in the study. Changes in rCBV values between diagnosis and first tumor progression were significant (p < 0.001), with a mean and median decreases of 32% and 46%, respectively. Mean rCBV values were also different (p < 0.01) when tumors progressed distally (radiation field rCBV values of 1.679 versus 3.409 distally). However, changes and, therefore, low rCBV values after radiotherapy in tumor recurrence were independent of time. CONCLUSION Chemoradiation alters tumor perfusion and rCBV values may be decreased in the setting of tumor progression. Changes in rCBV values with respect to diagnosis, with low rCBV in tumor progression, are independent of time but related to the site of recurrence.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain.
| | - E Salvador
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Cardenas
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Romero
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - C Lechuga
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - Z Chen
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Martinez de Aragon
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Perez-Nuñez
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Hernandez-Lain
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Sepulveda
- Department of Medical Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - O Toldos
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - V Rodriguez-Gonzalez
- Department of Radiation Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Ramos
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
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Saito N, Hirai N, Sato S, Hayashi M, Iwabuchi S. Delayed Pseudoprogression in Glioblastoma Patients Treated With Tumor-Treating Fields. Cureus 2024; 16:e55147. [PMID: 38558596 PMCID: PMC10979818 DOI: 10.7759/cureus.55147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Tumor-treating fields (TTFields) is an established treatment modality for glioblastoma. False progression to chemoradiation is a known problem in patients with glioblastoma multiforme (GBM), with most cases occurring within three months of radiation therapy. In this report, we present two cases of delayed pseudoprogression caused by TTFields. Two patients with GBM who received TTFields showed signs of radiographic progression six months after the completion of radiation therapy. Patient 1 was a 37-year-old female with a glioblastoma in the right temporal lobe. Patient 2 was a 70-year-old male with glioblastoma in the left temporal lobe. Both patients received radiation therapy, followed by temozolomide (TMZ) maintenance therapy and TTFields. Patient 1 underwent a second resection; however, the pathology revealed only a treatment effect, and the final diagnosis was a pseudoprogression. In Case 2, the disease resolved with steroid therapy alone. In both patients, the lesions appeared later than during the typical pseudoprogression period. A recent study reported that TTFields increase the permeability of the plasma cell membrane, which may result in further leakage of gadolinium into the extracellular lumen. Further studies are needed to better characterize delayed pseudoprogression and improve treatment outcomes.
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Affiliation(s)
- Norihiko Saito
- Neurosurgery, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Nozomi Hirai
- Neurosurgery, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Sho Sato
- Neurosurgery, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Morito Hayashi
- Neurosurgery, Toho University Ohashi Medical Center, Tokyo, JPN
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Esparragosa Vazquez I, Ndiaye M, Di Stefano AL, Younan N, Larrieu-Ciron D, Seyve A, Picart T, Meyronet D, Boutet C, Vassal F, Carpentier C, Figarella-Branger D, Dehais C, Forest F, Rivoirard R, Ducray F. T2-Fluid-attenuated inversion recovery (FLAIR) pseudoprogression in patients with anaplastic oligodendrogliomas treated with procarbazine, lomustine and vincristine (PCV) chemotherapy alone. Eur J Neurol 2023; 30:2879-2883. [PMID: 37204066 DOI: 10.1111/ene.15873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pseudoprogression in gliomas has been extensively described after radiotherapy with or without chemotherapy, but not after chemotherapy alone. Here we describe the occurrence of pseudoprogression in patients with anaplastic oligodendrogliomas treated with postoperative procarbazine, lomustine and vincristine (PCV) chemotherapy alone. METHODS We retrospectively reviewed the medical and radiological files of patients with 1p/19q codeleted, IDH-mutant anaplastic oligodendrogliomas treated with PCV chemotherapy alone who presented magnetic resonance imaging (MRI) modifications suggestive of tumour progression and in whom the final diagnosis was a pseudoprogression. RESULTS We identified six patients. All patients underwent a surgical resection and were treated with PCV chemotherapy without radiotherapy. After a median of 11 months following the initiation of chemotherapy (range: 3-49 months), the patients developed asymptomatic white matter MRI modifications around the surgical cavity leading to the suspicion of a tumour progression. These modifications appeared as hyperintense on T2-fluid-attenuated inversion recovery (FLAIR) sequence, hypointense on T1 sequence, and lacked mass effect (0/6), contrast enhancement (0/6), restriction on diffusion-weighted imaging (0/4), relative cerebral blood volume (rCBV) increase on perfusion MRI (0/4), and hypermetabolism on 18 F-fluoro-L-dopa positron emission tomography (18 F-DOPA PET) scan (0/3). One patient underwent a surgical resection demonstrating no tumour recurrence; the five other patients were considered as having post-therapeutic modifications based on imaging characteristics. After a median follow-up of 4 years all patients were progression-free. CONCLUSIONS Anaplastic oligodendroglioma patients treated with postoperative PCV chemotherapy alone occasionally develop T2/FLAIR hyperintensities around the surgical cavity that can wrongly suggest tumour progression. Multimodal imaging and close follow-up should be considered in this situation.
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Affiliation(s)
| | - Mané Ndiaye
- Neuro-Oncology Department, Centre Georges François Leclerc, Dijon, France
| | | | - Nadia Younan
- Neuro-Oncology Department, Hôpital Foch, Suresnes, France
| | - Delphine Larrieu-Ciron
- Neuro-Oncology Department, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Antoine Seyve
- Neuro-Oncology Department, Hospices Civils of Lyon, Lyon, France
| | - Thiébaud Picart
- Neuro-Surgery Department, Hospices Civils of Lyon, Lyon, France
| | - David Meyronet
- Neuropathology Department, Hospices Civils of Lyon, Lyon, France
- Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France
| | - Claire Boutet
- Radiology Department, University Hospital of St-Etienne, St-Etienne, France
| | - François Vassal
- Neuro-Surgery Department, University Hospital of St-Etienne, St-Etienne, France
| | - Catherine Carpentier
- Department of Neurology 2-Mazarin, APHP, University Hospital Pitié Salpêtrière-Charles Foix, Paris, France
| | | | - Caroline Dehais
- Department of Neurology 2-Mazarin, APHP, University Hospital Pitié Salpêtrière-Charles Foix, Paris, France
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Romain Rivoirard
- Oncology Department, Hôpital Privé de la Loire, Saint Etienne, France
| | - François Ducray
- Neuro-Oncology Department, Hospices Civils of Lyon, Lyon, France
- Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France
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