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Early Pseudoprogression following Chemoradiotherapy in Glioblastoma Patients: The Value of RANO Evaluation.

Linhares P, Carvalho B, Figueiredo R, Reis RM, Vaz R - J Oncol (2013)

Bottom Line: Updated RANO criteria were used for the evaluation of the pre-RT and post-RT MRI and compared to classic Macdonald criteria.Conclusion.In this cohort, the frequency of pseudoprogression varied between 13% and 24%, being overdiagnosed by older Macdonald criteria, which emphasizes the importance of RANO criteria and new radiological biomarkers for correct response evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hospital de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ; Faculty of Medicine, University of Porto, Praça Gomes Teixeira, 4099-002 Porto, Portugal.

ABSTRACT
Introduction. The aim of this study was to determine the frequency of pseudoprogression in a cohort of glioblastoma (GBM) patients following radiotherapy/temozolomide (RT/TMZ) by comparing Macdonald criterial to Response Assessment in Neuro-Oncology (RANO) criteria. The impact on prognosis and survival analysis was also studied. Materials and Methods. All patients receiving RT/TMZ for newly diagnosed GBM from January 2005 to December 2009 were retrospectively evaluated, and demographic, clinical, radiographic, treatment, and survival data were reviewed. Updated RANO criteria were used for the evaluation of the pre-RT and post-RT MRI and compared to classic Macdonald criteria. Survival data was evaluated using the Kaplan-Meier and log-rank analysis. Results and Discussion. 70 patients were available for full radiological response assessment. Early progression was confirmed in 42 patients (60%) according to Macdonald criteria and 15 patients (21%) according to RANO criteria. Pseudoprogression was identified in 10 (23.8%) or 2 (13.3%) patients in Macdonald and RANO groups, respectively. Cumulative survival of pseudoprogression group was higher than that of true progression group and not statistically different from the non-progressive disease group. Conclusion. In this cohort, the frequency of pseudoprogression varied between 13% and 24%, being overdiagnosed by older Macdonald criteria, which emphasizes the importance of RANO criteria and new radiological biomarkers for correct response evaluation.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier analysis of overall survival curves according to different progression groups: true-progressive disease (tPD), blue; Pseudoprogression (psPD), green; Nonprogressive disease (nPD), yellow; and different response assessment criteria: (a), Macdonald; (b), RANO.
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fig3: Kaplan-Meier analysis of overall survival curves according to different progression groups: true-progressive disease (tPD), blue; Pseudoprogression (psPD), green; Nonprogressive disease (nPD), yellow; and different response assessment criteria: (a), Macdonald; (b), RANO.

Mentions: Survival analysis for subgroups of progression according to Macdonald criteria revealed a median overall survival of 12 months [95% CI (8.7, 15.3)] for the group of true progressive disease and 21 months [CI 95% (14.5, 27.5)] for the group of nonprogressive disease. Pseudoprogression group had a median overall survival of 24 months [CI 95% (11.6, 36.4)], not statistically different from the nonprogressive group (P = 0.456). According to RANO criteria, true progressive disease group had a median overall survival of 9 months [95% CI (3.7, 14.3)] and nonprogressive disease group had a median overall survival of 16 months [95% CI (13.8, 18.2)]. Pseudoprogression group was limited to 2 patients with an estimate median overall survival of 13 months, not statistically different from the nonprogressive group (P = 0.639) (Figure 3). Median progression-free survival for true progressive disease, pseudoprogression, and nonprogressive disease was 6 months, 16 months, and 12 months, respectively (Macdonald criteria applied) and 6 months, 7 months, and 11 months, respectively (RANO criteria applied) (Figure 4).


Early Pseudoprogression following Chemoradiotherapy in Glioblastoma Patients: The Value of RANO Evaluation.

Linhares P, Carvalho B, Figueiredo R, Reis RM, Vaz R - J Oncol (2013)

Kaplan-Meier analysis of overall survival curves according to different progression groups: true-progressive disease (tPD), blue; Pseudoprogression (psPD), green; Nonprogressive disease (nPD), yellow; and different response assessment criteria: (a), Macdonald; (b), RANO.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3755387&req=5

fig3: Kaplan-Meier analysis of overall survival curves according to different progression groups: true-progressive disease (tPD), blue; Pseudoprogression (psPD), green; Nonprogressive disease (nPD), yellow; and different response assessment criteria: (a), Macdonald; (b), RANO.
Mentions: Survival analysis for subgroups of progression according to Macdonald criteria revealed a median overall survival of 12 months [95% CI (8.7, 15.3)] for the group of true progressive disease and 21 months [CI 95% (14.5, 27.5)] for the group of nonprogressive disease. Pseudoprogression group had a median overall survival of 24 months [CI 95% (11.6, 36.4)], not statistically different from the nonprogressive group (P = 0.456). According to RANO criteria, true progressive disease group had a median overall survival of 9 months [95% CI (3.7, 14.3)] and nonprogressive disease group had a median overall survival of 16 months [95% CI (13.8, 18.2)]. Pseudoprogression group was limited to 2 patients with an estimate median overall survival of 13 months, not statistically different from the nonprogressive group (P = 0.639) (Figure 3). Median progression-free survival for true progressive disease, pseudoprogression, and nonprogressive disease was 6 months, 16 months, and 12 months, respectively (Macdonald criteria applied) and 6 months, 7 months, and 11 months, respectively (RANO criteria applied) (Figure 4).

Bottom Line: Updated RANO criteria were used for the evaluation of the pre-RT and post-RT MRI and compared to classic Macdonald criteria.Conclusion.In this cohort, the frequency of pseudoprogression varied between 13% and 24%, being overdiagnosed by older Macdonald criteria, which emphasizes the importance of RANO criteria and new radiological biomarkers for correct response evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hospital de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ; Faculty of Medicine, University of Porto, Praça Gomes Teixeira, 4099-002 Porto, Portugal.

ABSTRACT
Introduction. The aim of this study was to determine the frequency of pseudoprogression in a cohort of glioblastoma (GBM) patients following radiotherapy/temozolomide (RT/TMZ) by comparing Macdonald criterial to Response Assessment in Neuro-Oncology (RANO) criteria. The impact on prognosis and survival analysis was also studied. Materials and Methods. All patients receiving RT/TMZ for newly diagnosed GBM from January 2005 to December 2009 were retrospectively evaluated, and demographic, clinical, radiographic, treatment, and survival data were reviewed. Updated RANO criteria were used for the evaluation of the pre-RT and post-RT MRI and compared to classic Macdonald criteria. Survival data was evaluated using the Kaplan-Meier and log-rank analysis. Results and Discussion. 70 patients were available for full radiological response assessment. Early progression was confirmed in 42 patients (60%) according to Macdonald criteria and 15 patients (21%) according to RANO criteria. Pseudoprogression was identified in 10 (23.8%) or 2 (13.3%) patients in Macdonald and RANO groups, respectively. Cumulative survival of pseudoprogression group was higher than that of true progression group and not statistically different from the non-progressive disease group. Conclusion. In this cohort, the frequency of pseudoprogression varied between 13% and 24%, being overdiagnosed by older Macdonald criteria, which emphasizes the importance of RANO criteria and new radiological biomarkers for correct response evaluation.

No MeSH data available.


Related in: MedlinePlus