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Pseudoprogression: Relevance With Respect to Treatment of High-Grade Gliomas

  • CNS Malignancies
  • Published:
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Opinion statement

The post-treatment imaging assessment of high-grade gliomas remains challenging notwithstanding the increased utilization of advanced MRI and PET imaging. Several post-treatment imaging entities are recognized including: late-delayed radiation injury, including radionecrosis mimicking tumor progression; early-delayed (within 6 months of temozolomide-based chemoradiation) post-treatment radiographic changes, herein referred to as pseudoprogression (the subject of this review); early post-treatment changes following local glioma therapy (i.e. biodegradable BCNU wafer implantation or stereotactic radiotherapy); and pseudoresponse, seen following treatment with angiogenic inhibition based therapy such as bevacizumab. A literature review searched specifically for “pseudoprogression” within the last 5 years (2005–2010). Approximately 24 recent papers were identified and reviewed in detail. Eight small population-based studies demonstrate 26–58% (median 49%) of glioblastoma patients treated with chemoradiotherapy manifest early disease progression at first post-radiotherapy imaging. Patients with early radiographic disease progression continued on planned therapy, and a median of 38% (range 28–66%) showed radiographic improvement or stabilization and were defined retrospectively as manifesting pseudoprogression. In conclusion, pseudoprogression is a frequent early post-treatment imaging change that at present is not easily differentiated from tumor progression by anatomic or physiologic brain imaging. Consequently, an operational definition of pseudoprogression has been adopted by the Response Assessment in Neuro-Oncology Working Group wherein either the index (i.e. target) lesion stabilizes or diminishes in size on continued post-radiation (temozolomide) therapy as determined by follow-up radiologic imaging.

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Disclosures

No potential conflicts of interest relevant to this article were reported.

The authors report no conflict of interest.

MCC, JF and DB conducted the statistical analysis for this manuscript.

MCC, JF and DB collected and analyzed data.

No personal communications cited in the manuscript.

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Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Ave E, MS: G4-940, Seattle, WA, 98109, USA

    Marc C. Chamberlain MD

  2. Department of Radiology, University of Washington, Seattle, WA, USA

    James Fink MD

  3. Department of Pathology, University of Washington, Seattle, WA, USA

    Donald Born MD

  4. Department of Neurology and Neurological Surgery, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Marc C. Chamberlain MD

Authors
  1. James Fink MD
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  2. Donald Born MD
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  3. Marc C. Chamberlain MD
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Correspondence to Marc C. Chamberlain MD.

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Left running head: CNS Malignancies

Right running head: Pseudoprogression: Relevance With Respect to Treatment of High-Grade Gliomas Fink, Born, and Chamberlain

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Fink, J., Born, D. & Chamberlain, M.C. Pseudoprogression: Relevance With Respect to Treatment of High-Grade Gliomas. Curr. Treat. Options in Oncol. 12, 240–252 (2011). https://doi.org/10.1007/s11864-011-0157-1

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  • DOI: https://doi.org/10.1007/s11864-011-0157-1

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