Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Holland Proton Therapy Center, Delft, the Netherlands.
Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Radiother Oncol. 2023 Jul;184:109674. doi: 10.1016/j.radonc.2023.109674. Epub 2023 Apr 20.
The interpretation of new enhancing lesions after radiotherapy for diffuse glioma remains a clinical challenge. We sought to characterize and classify new contrast enhancing lesions in a historical multicenter cohort of patients with IDH mutated grade 2 diffuse glioma treated with photon therapy.
We reviewed all follow-up MRI's of all patients treated with radiotherapy for histologically confirmed, IDH mutated diffuse grade 2 glioma between 1-1-2007 and 31-12-2018 in two tertiary referral centers. Disease progression (PD) was defined in accordance with the RANO criteria for progressive disease in low grade glioma. Pseudoprogression (psPD) was defined as any transient contrast-enhancing lesion between the end of radiotherapy and PD, or any new contrast-enhancing lesion that remained stable over a period of 12 months in patients who did not exhibit PD.
A total of 860 MRI's of 106 patients were reviewed. psPD was identified in 24 patients (23%) on 76 MRI's. The cumulative incidence of psPD was 13% at 1 year, 22% at 5 years, and 28% at 10 years. The mean of the observed maximal volume of psPD was 2.4 cc. The median Dmin in psPD lesions was 50.1 Gy. The presence of an 1p/19q codeletion was associated with an increased risk of psPD (subhazard ratio 2.34, p = 0.048). psPD was asymptomatic in 83% of patients.
The cumulative incidence of psPD in grade 2 diffuse glioma increases over time. Consensus regarding event definition and statistical analysis is needed for comparisons between series investigating psPD.
弥漫性胶质瘤放疗后新增强病灶的解读仍然是临床面临的挑战。我们旨在对经光子放疗治疗的 IDH 突变型 2 级弥漫性胶质瘤的历史多中心队列中的新增强病灶进行特征描述和分类。
我们对两家三级转诊中心于 2007 年 1 月 1 日至 2018 年 12 月 31 日期间治疗的经组织学证实的 IDH 突变型 2 级弥漫性胶质瘤的所有患者的所有随访 MRI 进行了回顾性研究。根据 RANO 标准，疾病进展（PD）定义为低级别胶质瘤的进展性疾病。假性进展（psPD）定义为放疗结束至 PD 之间任何短暂性增强病灶，或在未出现 PD 的患者中任何新的增强病灶在 12 个月期间保持稳定。
共回顾了 106 例患者的 860 份 MRI。76 份 MRI 中有 24 例（23%）患者发现 psPD。psPD 的累积发生率在 1 年时为 13%，在 5 年时为 22%，在 10 年时为 28%。psPD 病变的观察到的最大体积平均值为 2.4cc。psPD 病变的最小剂量中位数为 50.1Gy。存在 1p/19q 联合缺失与 psPD 的风险增加相关（亚危险比 2.34，p=0.048）。83%的患者 psPD 无症状。
2 级弥漫性胶质瘤的 psPD 累积发生率随时间增加。需要就 psPD 事件定义和统计分析达成共识，以便对研究 psPD 的系列进行比较。
