Mayoral M, Castañer E, Gallardo X, Andreu M, Dalmau E, Garcia Y
Servicio de Radiodiagnóstico, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
Servicio de Radiodiagnóstico, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
Radiologia (Engl Ed). 2019 Nov-Dec;61(6):498-505. doi: 10.1016/j.rx.2019.05.004. Epub 2019 Jul 9.
Immunotherapy is a new treatment in advanced lung cancer that works by modulating the immune response against malignant cells. One aspect that is challenging for radiologists in the evaluation of the response to immunotherapy is the phenomenon of pseudoprogression, in which the infiltration of inflammatory cells causes lesions to increase in size or new lesions to appear and then decrease in size or disappear. Pseudoprogression actually represents a response to treatment. We aimed to determine the frequency of pseudoprogression in patients with advanced stages of lung cancer treated with nivolumab.
We included 56 patients with advanced stages of lung cancer treated with nivolumab as a second-line or later treatment. We analyzed CT studies done while patients were undergoing nivolumab treatment. Tumor pseudoprogression was defined as an increase in the size of lesions or appearance of new lesions followed by a decrease in size or disappearance of these lesions on follow-up CT studies 4 to 8 weeks later. We did a descriptive analysis.
In 15 patients, it was impossible to evaluate possible pseudoprogression because a second CT study was unavailable due to change of treatment or death. Tumor pseudoprogression was observed in 5 (12.2%) of the 41 patients, in most cases within 12 weeks of treatment initiation (in the fourth cycle). A second episode of pseudoprogression occurred in 2 (40%) of the 5 patients with an initial episode; the second episode occurred more than 12 weeks after treatment initiation.
Tumor pseudoprogression occurred in 12.2% of patients with advanced stage lung cancer treated with nivolumab. An increase in lesion size or the appearance of new lesions must be assessed over time to avoid mistaking pseudoprogression for true progression of disease.
免疫疗法是晚期肺癌的一种新治疗方法，其通过调节针对恶性细胞的免疫反应发挥作用。在评估免疫疗法反应时，对放射科医生而言具有挑战性的一个方面是假性进展现象，即炎症细胞浸润导致病灶增大或出现新病灶，随后病灶又缩小或消失。假性进展实际上代表了对治疗的反应。我们旨在确定接受纳武单抗治疗的晚期肺癌患者中假性进展的发生率。
我们纳入了56例接受纳武单抗作为二线或更后续治疗的晚期肺癌患者。我们分析了患者接受纳武单抗治疗期间所做的CT研究。肿瘤假性进展定义为病灶大小增加或出现新病灶，随后在4至8周后的随访CT研究中这些病灶缩小或消失。我们进行了描述性分析。
15例患者因治疗改变或死亡而无法获得第二次CT研究，故无法评估可能的假性进展。在41例患者中，有5例（12.2%）观察到肿瘤假性进展，大多数情况发生在治疗开始后的12周内（第四个周期）。5例初次发生假性进展的患者中有2例（40%）出现了第二次假性进展；第二次假性进展发生在治疗开始12周之后。
接受纳武单抗治疗的晚期肺癌患者中，肿瘤假性进展的发生率为12.2%。必须随时间评估病灶大小的增加或新病灶的出现，以避免将假性进展误认为疾病的真正进展。
