AI Article Synopsis

  • A study analyzed the occurrence and characteristics of pseudoprogression in high-grade gliomas with isocitrate dehydrogenase mutations (IDHmt HGG), focusing on patients treated with radiotherapy within the French POLA network.
  • The research found that 19% of patients experienced pseudoprogression, typically developing asymptomatic contrast-enhanced lesions within 2 years post-treatment, with the occurrence linked to the use of certain chemotherapies (PCV CT).
  • The study highlights a concerning trend of misdiagnosis, where 17% of patients with initial true progression may have actually had pseudoprogression, suggesting that careful evaluation is necessary in the early stages post-radiotherapy.

Article Abstract

Background: Incidence and characteristics of pseudoprogression in isocitrate dehydrogenase-mutant high-grade gliomas (IDHmt HGG) remain to be specifically described.

Methods: We analyzed pseudoprogression characteristics and explored the possibility of pseudoprogression misdiagnosis in IDHmt HGG patients, treated with radiotherapy (RT) (with or without chemotherapy [CT]), included in the French POLA network. Pseudoprogression was analyzed in patients with MRI available for review (reference cohort, n = 200). Pseudoprogression misdiagnosis was estimated in this cohort and in an independent cohort (control cohort, n = 543) based on progression-free survival before and after first progression.

Results: In the reference cohort, 38 patients (19%) presented a pseudoprogression after a median time of 10.5 months after RT. Pseudoprogression characteristics were similar across IDHmt HGG subtypes. In most patients, it consisted of the appearance of one or several infracentimetric, asymptomatic, contrast-enhanced lesions occurring within 2 years after RT. The only factor associated with pseudoprogression occurrence was adjuvant PCV CT. Among patients considered as having a first true progression, 7 out of 41 (17%) in the reference cohort and 35 out of 203 (17%) in the control cohort were retrospectively suspected to have a misdiagnosed pseudoprogression. Patients with a misdiagnosed pseudoprogression were characterized by a time to event and an outcome similar to that of patients with a pseudoprogression but presented with larger and more symptomatic lesions.

Conclusion: In patients with an IDHmt HGG, pseudoprogression occurs later than in IDH-wildtype glioblastomas and seems not only frequent but also frequently misdiagnosed. Within the first 2 years after RT, the possibility of a pseudoprogression should be carefully considered.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013645PMC
http://dx.doi.org/10.1093/neuonc/noac194DOI Listing

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