Pseudoprogression after Radiochemotherapy for High-grade Glioma_West China Medical Journal

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Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

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Keywords：

胶质瘤; 假性进展; 替莫唑胺; 放化疗

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【摘要】　目的　探讨高级别胶质瘤患者放射、化学治疗后假性进展的临床特点、诊断与处理。　方法　分析2008年6月-2009年6月接受综合治疗的31例高级别胶质瘤患者临床资料，对假性进展的患者进行回顾分析，按照实体瘤疗效评判标准应用磁共振进行疗效评价。　结果　 31例术后病理诊断为高级别胶质瘤的患者，替莫唑胺（TMZ）同期放射、化学治疗后维持TMZ辅助化学疗法，放射治疗后早期发生假性进展4例（14%)。　结论　对于TMZ同期放射、化学治疗后早期出现的影像学疑似进展，不要急于下结论，了解假性进展的临床特点，结合功能影像学检查可能会有助于临床医生的判断与处理。
【Abstract】　Objective　 To discuss the clinical feature, diagnosis, and management of pseudoprogression after radiochemotherapy of high-grade glioma patients. 　Methods　 The clinical data of 31 high-grade glioma patients who underwent postoperative radiochemotherapy from June 2008 to June 2009 were reviewed. Pseudoprogression cases were analyzed. The treatment response was assessed through magnetic resonance imaging (MRI) according to the established response evaluation criteria in solid tumors.　Results　 All the 31 high grade gioma patients received postoperative fractioned radiotherapy with concomitant TMZ chemotherapy, followed by TMZ maintenance chemotherapy. Four cases of pseudoprogression occurred after radiotherapy (14%).　Conclusion　 Doctors should be careful in making early diagnosis for the suspected early progression after TMZ concomitant radiochemotherapy. It would be helpful for management to combine the clinical features of pseudoprogression with functional imaging technology.

Citation： Pseudoprogression after Radiochemotherapy for Highgrade Glioma. Pseudoprogression after Radiochemotherapy for High-grade Glioma. West China Medical Journal, 2011, 26(4): 513-516. doi: Copy

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13.	Weybright P, Sundgren PC, Maly P, et al. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy[J]. AJR Am J Roentgenol, 2005, 185(6): 1471-1476.
14.	Rock JP, Scarpace L, Hearshen D, et al. Associations among magnetic resonance sperctroscopy, apparent diffusion coefficients, and image-guided histopathology with special attention to radiation necrosis[J]. Neurosurgery, 2004, 54(5): 1111-1117.
15.	Jeon HJ, Kong DS, Park KB, et al. Clinical outcome of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastaomas: single-center experience[J]. Clin Neurol Neurosurg, 2009, 111(8): 679-682.
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1. 　Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma[J]. N Eng J Med, 2005, 352(10): 987-996.
2. 　Clarke JL, Iwamoto FM, Sul J, et al. Randomized phase II trial of chemoradiotherapy followed by either dose-dense or metronomic temozolomide for newly diagnosed glioblastoma[J]. J Clin Oncol, 2009, 27(23): 3861-3867.
3. 　Hoffman WF, Levin VA, Wilson CB. Evaluation of malignant glioma patients during the postirradiation period[J]. J Neurosurg, 1979, 50(5): 624-628.
4. 　de Witt MC, de Bruin HG, Ejkenboom W, et al. Immediate post-radiotherapy changes in malignant glioma can mimic tumor progression[J]. Neurology, 2004, 63(3): 535-537.
5. 　Chaskis C, Neyns B, Michotte A, et al. Pseudoprogression after radiotherapy with concurrent temozolomide for high-grade glioma:clinical observation and working recommendations[J]. Surg Neurol, 2009, 72(4): 423-428.
6. 　Chamberlain MC, Glantz MJ, Chalmers L, et al. Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastoma[J]. J Neurooncol, 2007, 82(1): 81-83.
7. 　李刚, 牟永告, 魏大年, 等. 综合治疗中脑胶质瘤的假性进展(附15例报告)[J]. 中国神经精神疾病杂志, 2009, 35(7):409-412.
8. 　Rodemann HP, Blaese MA. Responses of normal cells to ionizing radiation[J]. Semin Radiat Oncol, 2007, 17(2): 81-88.
9. 　Wong CS, van der Kogel AJ. Mechanisms of radiation injury to the central nervous system: implications for neuroprotection[J]. Mol Interv, 2004, 4(5): 273-284.
10. 　Nordal RA, Nagy A, Pintilie M, et al. Hypoxia and hypoxia-inducible factor-1 target genes in central nervous system radiation injury: a role for vascular endothelial growth factor[J]. Clin Cancer Res, 2004, 10(10): 3342-3353.
11. 　Danson SJ, Middleton MR. Temozolomide: a novel oral alkylating agent[J]. Expert Rev Anticancer Ther, 2001, 1(1):13-19.
12. 　Brandes AA, Franceschi E, Tosoni A, et al. MGMT promoter methylation status can predict the incidence and outcome of pseudoprogression after concomitant radiochemotherapy in newly diagnosed glioblastoma patients[J]. J Clin Oncol, 2008, 26 (13): 2192-2197.
13. 　Weybright P, Sundgren PC, Maly P, et al. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy[J]. AJR Am J Roentgenol, 2005, 185(6): 1471-1476.
14. 　Rock JP, Scarpace L, Hearshen D, et al. Associations among magnetic resonance sperctroscopy, apparent diffusion coefficients, and image-guided histopathology with special attention to radiation necrosis[J]. Neurosurgery, 2004, 54(5): 1111-1117.
15. 　Jeon HJ, Kong DS, Park KB, et al. Clinical outcome of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastaomas: single-center experience[J]. Clin Neurol Neurosurg, 2009, 111(8): 679-682.
16. 　Chen W. Clinical applications of PET in brain tumors[J]. J Nucl Med, 2007, 48(9): 1468-1481.

West China Medical Journal

Pseudoprogression after Radiochemotherapy for High-grade Glioma

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