Odette Cancer Centre, University of Toronto, Ontario, Canada.
Can J Neurol Sci. 2010 Jan;37(1):36-42. doi: 10.1017/s0317167100009628.
Pseudoprogression (psPD) is now recognised following radiotherapy with concurrent temozolomide (RT/TMZ) for glioblastoma multiforme (GBM). The aim of this study was to determine the incidence of psPD following RT/TMZ and the effect of psPD on prognosis.
MATERIALS/METHODS: All patients receiving RT/TMZ for newly diagnosed GBM were identified from a prospective database. Clinical and radiographic data were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within eight weeks of completing RT/TMZ. Pseudoprogression was defined as early progression with subsequent disease stabilization, without salvage therapy, for at least six months from completion of RT/TMZ. The primary outcome was overall survival (Kaplan-Meier) and log rank analysis was used to compare groups.
Out of 111 patients analyzed, 104 were evaluable for radiological response. Median age was 58 years and median follow-up 55 weeks. Early progression was confirmed in 26% and within this group 32% had psPD. Median survival for the whole cohort was 56.7 weeks [95% CI (51.0, 71.3)]. Median survival for patients with psPD was significantly higher than for patients with true early progression (124.9 weeks versus 36.0 weeks, p = 0.0286).
Approximately one third of patients with early progression were found to have psPD which was associated with a favourable prognosis. Maintenance TMZ should not be abandoned on the basis of seemingly discouraging imaging features identified within the first three months after RT/TMZ.
在接受同步替莫唑胺（RT/TMZ）放化疗治疗多形性胶质母细胞瘤（GBM）后，现在已经认识到假性进展（psPD）。本研究的目的是确定 RT/TMZ 后 psPD 的发生率及其对预后的影响。
材料/方法：从一个前瞻性数据库中确定了所有接受 RT/TMZ 治疗新诊断的 GBM 的患者。回顾性回顾了临床和影像学数据。早期进展定义为 RT/TMZ 期间或完成后八周内的影像学进展（RECIST 标准）。假性进展定义为 RT/TMZ 完成后至少六个月内早期进展伴有随后疾病稳定，没有挽救治疗。主要结局是总生存期（Kaplan-Meier），对数秩分析用于比较组。
在分析的 111 名患者中，104 名可评估放射学反应。中位年龄为 58 岁，中位随访时间为 55 周。26%的患者确认早期进展，其中 32%的患者有 psPD。整个队列的中位总生存期为 56.7 周[95%CI（51.0，71.3）]。有 psPD 的患者的中位生存期明显长于有真正早期进展的患者（124.9 周与 36.0 周，p = 0.0286）。
大约三分之一的早期进展患者被发现有 psPD，这与有利的预后相关。不应该根据 RT/TMZ 后前三个月内发现的看似令人沮丧的影像学特征放弃维持 TMZ。
