BACKGROUND: Increasing mass effect following radiation therapy (RT) in patients with low-grade gliomas (LGGs) can be mistaken for tumor progression and/or malignant degeneration. Distinguishing pseudoprogression (PP) from true progression is crucial, with vastly different treatment approaches and prognoses. PROCEDURE: Patients treated with RT for LGGs through the Children's Hospital of Pittsburgh Neuro-Oncology Program are considered to have PP and managed conservatively if they develop increased mass effect within 3 years of RT. Pre-RT tumor area was compared to the maximum tumor size following RT and the size on the last follow-up scan by a central reviewer. RESULTS: Twenty-four children, median age 13 years, received external beam RT for LGG between March 2000 and August 2011. Thirteen patients (54.2%) developed an increase in tumor size compared to baseline beginning at a median of 6 months after RT and lasting for a median of 2.1 years (range 6.5 months to 5.1 years). Maximum tumor enlargement occurred at a median of 8 months after RT, with a range (5 months to 4.2 years). In all 13 cases, the tumor eventually decreased in size without additional anti-tumor therapy. Two patients (8.3%) developed true tumor progression. With a median follow-up of 4.9 years (range 1.0-12.4 years), all patients are alive. CONCLUSIONS: Pseudoprogression occurred in more than half of the children with LGG following RT, typically beginning within 8 months and often running a very protracted course. Late presentations can also occur.
BACKGROUND: Increasing mass effect following radiation therapy (RT) in patients with low-grade gliomas (LGGs) can be mistaken for tumor progression and/or malignant degeneration. Distinguishing pseudoprogression (PP) from true progression is crucial, with vastly different treatment approaches and prognoses. PROCEDURE: Patients treated with RT for LGGs through the Children's Hospital of Pittsburgh Neuro-Oncology Program are considered to have PP and managed conservatively if they develop increased mass effect within 3 years of RT. Pre-RT tumor area was compared to the maximum tumor size following RT and the size on the last follow-up scan by a central reviewer. RESULTS: Twenty-four children, median age 13 years, received external beam RT for LGG between March 2000 and August 2011. Thirteen patients (54.2%) developed an increase in tumor size compared to baseline beginning at a median of 6 months after RT and lasting for a median of 2.1 years (range 6.5 months to 5.1 years). Maximum tumor enlargement occurred at a median of 8 months after RT, with a range (5 months to 4.2 years). In all 13 cases, the tumor eventually decreased in size without additional anti-tumor therapy. Two patients (8.3%) developed true tumor progression. With a median follow-up of 4.9 years (range 1.0-12.4 years), all patients are alive. CONCLUSIONS: Pseudoprogression occurred in more than half of the children with LGG following RT, typically beginning within 8 months and often running a very protracted course. Late presentations can also occur.
Authors: Joel M Cherlow; Dennis W W Shaw; Linda R Margraf; Daniel C Bowers; Jie Huang; Maryam Fouladi; Arzu Onar-Thomas; Tianni Zhou; Ian F Pollack; Amar Gajjar; Sandy K Kessel; Patricia L Cullen; Kevin McMullen; John C Wellons; Thomas E Merchant Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-10 Impact factor: 7.038
Authors: Sophie E van West; Hein G de Bruin; Bart van de Langerijt; Annemarie T Swaak-Kragten; Martin J van den Bent; Walter Taal Journal: Neuro Oncol Date: 2017-05-01 Impact factor: 12.300
Authors: Ethan B Ludmir; Anita Mahajan; Arnold C Paulino; Jeremy Y Jones; Leena M Ketonen; Jack M Su; David R Grosshans; Mary Frances McAleer; Susan L McGovern; Yasmin A Lassen-Ramshad; Adekunle M Adesina; Robert C Dauser; Jeffrey S Weinberg; Murali M Chintagumpala Journal: Neuro Oncol Date: 2019-05-06 Impact factor: 12.300
Authors: Derek S Tsang; Erin S Murphy; John T Lucas; Pagona Lagiou; Sahaja Acharya; Thomas E Merchant Journal: J Neurooncol Date: 2017-07-27 Impact factor: 4.130