Department of Radiation Oncology, Adana Medical and Research Center, Baskent University Medical Faculty, Kisla Saglik Yerleskesi, Adana, Turkey.
Am J Clin Oncol. 2012 Jun;35(3):284-9. doi: 10.1097/COC.0b013e318210f54a.
To evaluate pathologically confirmed incidence of pseudoprogression and its impact on survival in glioblastoma multiforme (GBM) patients treated with radiotherapy and concurrent temozolomide (TMZ), followed by 6 months of TMZ maintenance therapy.
Sixty-three patients with histologic proof of GBM underwent 60 Gy (2 Gy/fr, 30 fractions) of brain radiotherapy concurrent with continuous 75 mg/m/d TMZ, followed by 6 cycles of maintenance TMZ (200 mg/m/d for 5 d, every 28 d). Response assessment was performed by magnetic resonance imaging every 2 months. All patients with radiologic doubt of early tumor progression (≤6 mo) underwent salvage surgery.
All patients underwent surgical resection. Gross total, subtotal resection, and biopsy were performed in 17 (27.0%), 32 (51.6%), and 14 (21.4%) patients, respectively. Lesion enlargement on first follow-up magnetic resonance imaging evidenced in 28 (44.4%) patients. Salvage pathologies revealed pseudoprogression in 12 of 28 (42.8%) patients corresponding to an overall pseudoprogression rate of 19%. Survival analysis revealed that patients with pseudoprogression had superior overall and progression-free survival rates at both 1 and 2 years (P<0.05 for each, respectively).
Current results indicates the urgency of need for novel imaging techniques and/or biochemical marker(s) that can better distinguish pseudoprogression from true progression to avoid unnecessary and potentially harmful surgical interventions in almost half of the radiologically progressive GBM patients. Our additional observation which suggests better survival for patients with pseudoprogression warrants to be studied in larger patient cohorts.
评估经放化疗联合替莫唑胺（TMZ）治疗后胶质母细胞瘤（GBM）患者中经病理证实的假性进展发生率及其对生存的影响，TMZ 治疗方案为放疗同步，6 个月 TMZ 维持治疗。
63 例经组织学证实的 GBM 患者接受 60 Gy（2 Gy/fr，30 次）脑部放疗，同时进行持续 75 mg/m/d TMZ 治疗，随后进行 6 个周期的 TMZ 维持治疗（200 mg/m/d，连用 5 天，每 28 天 1 个周期）。每 2 个月进行磁共振成像（MRI）评估。所有影像学提示早期肿瘤进展（≤6 个月）的患者进行挽救性手术。
所有患者均接受手术切除。17 例（27.0%）、32 例（51.6%）和 14 例（21.4%）患者分别行大体全切除、次全切除和活检。28 例（44.4%）患者在首次随访 MRI 上显示病灶增大。28 例患者中，12 例（42.8%）的挽救性病理显示假性进展，总体假性进展率为 19%。生存分析显示，假性进展患者的总生存和无进展生存在 1 年和 2 年时均明显提高（P<0.05）。
目前的结果表明，需要新的影像学技术和/或生化标志物来更好地区分假性进展和真性进展，以避免近一半影像学进展的 GBM 患者进行不必要和潜在有害的手术干预。我们的进一步观察表明，假性进展患者的生存更好，值得在更大的患者队列中进行研究。
