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Acta Neurologica Scandinavica.... 2013Pseudoprogression is a treatment-related effect seen on imaging in high-grade glioma. Enhancement of gadolinium contrast on control MRI can be misinterpreted as tumor... (Review)
Review
Pseudoprogression is a treatment-related effect seen on imaging in high-grade glioma. Enhancement of gadolinium contrast on control MRI can be misinterpreted as tumor recurrence and is also difficult to distinguish from radiation necrosis. Pseudoprogression is seen in up to 30% after standard treatment for glioblastoma multiforme (GBM), which is radiotherapy concurrent with chemotherapy with temozolomide (TMZ) and adjuvant cycles of TMZ. In this article, the current literature on pseudoprogression in high-grade glioma is reviewed by searches in PubMed. We also present two clinical cases, one of which had medullary pseudoprogression. No articles on this subentity of pseudoprogression were found in PubMed. Standard MRI with gadolinium contrast cannot differentiate between pseudoprogression, tumor recurrence and radiation necrosis. More advanced imaging techniques are often not available. Pseudoprogression seems to be related to methylated promoter of the O(6)--methyl-guanine methyl transferase (MGMT) gene, which is associated with improved treatment effect. Discontinuation or change of therapy on the basis of misinterpretation of MRI as disease progression is thus unfortunate. MRI should be interpreted with caution the first 6 months after standard treatment of high-grade glioma. In a GBM patient with contrast enhancement on MRI but few or no new symptoms and/or stable steroid doses, treatment should be continued and control imaging performed after 2-3 months.
Topics: Adult; Brain Neoplasms; DNA Modification Methylases; DNA Repair Enzymes; Disease Progression; Female; Genetic Predisposition to Disease; Glioma; Humans; Magnetic Resonance Imaging; Radiation Injuries; Retrospective Studies; Tumor Suppressor Proteins
PubMed: 23190289
DOI: 10.1111/ane.12047 -
Translational Cancer Research Dec 2019
PubMed: 35117135
DOI: 10.21037/tcr.2019.11.16 -
Journal of the Advanced Practitioner in... 2020Traditionally, treatment responses to chemotherapy had been based on Response Evaluation Criteria in Solid Tumours (RECIST) criteria evaluating tumor shrinkage,...
Traditionally, treatment responses to chemotherapy had been based on Response Evaluation Criteria in Solid Tumours (RECIST) criteria evaluating tumor shrinkage, stabilization of disease, growth, or development of new metastatic lesions. Using the same criteria to determine response in patients on immunotherapy has proven difficult, as some patients have initial growth of disease or develop new small metastatic lesions. The phenomenon of pseudoprogression is the initial growth of a primary lesion followed by latent or delayed response. Advanced practitioners need to be aware of the possibility of pseudoprogression in order to educate patients and help them stay on effective treatment.
PubMed: 33575068
DOI: 10.6004/jadpro.2020.11.7.6 -
Neuroimaging Clinics of North America Feb 2021Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is... (Review)
Review
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
Topics: Brain; Brain Neoplasms; Contrast Media; Diagnostic Imaging; Disease Progression; Fluorodeoxyglucose F18; Glioblastoma; Humans; Image Enhancement; Magnetic Resonance Imaging; Necrosis; Positron-Emission Tomography; Radiation Injuries; Radiopharmaceuticals; Treatment Outcome
PubMed: 33220823
DOI: 10.1016/j.nic.2020.09.010 -
Expert Review of Neurotherapeutics Apr 2013Over the last decade, pseudoprogression as a clinically significant entity affecting both glioma patient management and the conduct of clinical trials has been... (Review)
Review
Over the last decade, pseudoprogression as a clinically significant entity affecting both glioma patient management and the conduct of clinical trials has been recognized as a significant issue. The authors have summarized the literature relative to the incidence, chronological sequence, therapy-relatedness, impact of O-6-methylguanine-DNA methyltransferase methylation status and clinical features of pseudoprogression. Evidence regarding numerous neuroradiologic techniques to differentiate pseudoprogression from tumor recurrence is summarized. The implications of pseudoprogression on prognosis and clinical trial design are substantial, and are reviewed. Relative to this, the overlapping terms pseudoprogression and radiation necrosis are clarified to produce an appropriate basis for future consideration and research regarding this important biological phenomenon.
Topics: Antineoplastic Agents; Brain Neoplasms; Combined Modality Therapy; Dacarbazine; Disease Progression; Glioma; Humans; Neoplasm Recurrence, Local; Radiation Injuries; Radiotherapy; Temozolomide
PubMed: 23545054
DOI: 10.1586/ern.13.7 -
Canadian Journal of Neuroscience Nursing 2015Glioblastoma Multiforme (GBM) is the most common primary brain malignancy in humans and has a limited survival (median of 14.6 months). The goal of treatment is... (Review)
Review
Glioblastoma Multiforme (GBM) is the most common primary brain malignancy in humans and has a limited survival (median of 14.6 months). The goal of treatment is supportive rather than curative. Patients with a GBM struggle with uncertainty related to the illness trajectory. This uncertainty is compounded when possible progression is noted on imaging. Pseudoprogression (PsP) is an early treatment-related effect where there are apparent imaging changes suggesting progression, which then improve or stabilize through time. This paper provides a review of the literature on PsP in patients with high-grade gliomas. Insights in the patient and family experience of PsP will be informed by Mishel's Uncertainty in Illness Theory, research on patients' and families' neuro-oncology experience, and the author's nursing practice. Nursing implications will be proposed.
Topics: Attitude of Health Personnel; Attitude to Health; Brain Neoplasms; Disease Progression; Female; Glioblastoma; Humans; Male; Nursing Staff; Oncology Nursing; Patients; Uncertainty
PubMed: 26647493
DOI: No ID Found -
Radiologic Clinics of North America Nov 2019Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is... (Review)
Review
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
Topics: Brain; Brain Neoplasms; Diagnostic Imaging; Disease Progression; Glioblastoma; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Multimodal Imaging; Necrosis; Positron-Emission Tomography; Radiation Injuries
PubMed: 31582045
DOI: 10.1016/j.rcl.2019.07.003 -
Current Problems in Cancer Oct 2019Gastrointestinal cancers are very common cancers with colorectal being the fourth most common type, gastric the sixth, and esophageal the tenth. Although recent advances... (Review)
Review
Gastrointestinal cancers are very common cancers with colorectal being the fourth most common type, gastric the sixth, and esophageal the tenth. Although recent advances have been made in management including incorporation of antiangiogenic, anti-EGFR, and anti-HER2 directed therapies, overall their prognosis remains poor. Anti-PD-1 therapy with nivolumab and pembrolizumab are licensed for advanced chemorefractory gastroesophageal cancer and many other checkpoint inhibitor therapies are being assessed alone and in combination in these diseases. One of the challenges posed in assessing response to immunotherapy treatment is the phenomenon of pseudoprogression. This phenomenon, which is well described in patients with malignant melanoma is most frequently described as a size increase of contrast enhancing lesions or appearance of new lesions that stabilize or reduce in size with time. Most other solid tumors have a low incidence of pseudoprogression although cases have been reported for lung, head, and neck cancer and a range of gliomas. Herein we present 6 cases of patients with gastrointestinal cancers who were treated with anti-PD1 (programmed cell death) and anti-PD-L1 (programmed cell death ligand-1) antibodies, and experience pseudoprogression.
Topics: Adult; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; B7-H1 Antigen; Contrast Media; Disease Progression; Drug Resistance, Neoplasm; Female; Gastrointestinal Neoplasms; Humans; Male; Melanoma; Middle Aged; Nivolumab; Programmed Cell Death 1 Receptor; Protein Kinase Inhibitors; Skin Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30827742
DOI: 10.1016/j.currproblcancer.2019.01.008 -
Journal of Cancer Research and... Feb 2023Immunotherapy is a novel treatment option for various types of cancers. However, the optimal timing for response evaluation has not been well defined. Here, we present a... (Review)
Review
Immunotherapy is a novel treatment option for various types of cancers. However, the optimal timing for response evaluation has not been well defined. Here, we present a gastric cancer (GC) patient with microsatellite instability-high who experienced recurrence 5 years and 11 months after radical gastrectomy. Then, the patient was treated with radiotherapy, targeted drugs, and immunotherapy. Immunotherapy resulted in 5 months of continuous progression, accompanied by significantly increased tumor marker CA19-9. However, the patient exhibited a satisfactory response without altering the treatment. Based on this, we hypothesized that some persistent progression with elevated tumor markers, known as pseudoprogression (PsP), might be observed in patients with recurrent GC during immunotherapy. This process might be prolonged, but if the treatment is continued, it will eventually produce remarkable therapeutic effects. PsP might challenge the globally accepted immune response evaluation criteria for solid tumors.
Topics: Humans; Stomach Neoplasms; Disease Progression; Neoplasm Recurrence, Local; Adenocarcinoma; Immunotherapy
PubMed: 37006055
DOI: 10.4103/jcrt.jcrt_1050_22 -
Journal of Clinical Medicine May 2021We evaluated the incidence of pseudoprogression and indeterminate response (IR) in patients with lymphoma treated with immune checkpoint inhibitors (ICIs). A systematic... (Review)
Review
We evaluated the incidence of pseudoprogression and indeterminate response (IR) in patients with lymphoma treated with immune checkpoint inhibitors (ICIs). A systematic search of PubMed and EMBASE was performed up to 6 February 2021, using the keywords "lymphoma," "immunotherapy," and "pseudoprogression." Random-effects models were used to calculate both pooled incidence of pseudoprogression patients with lymphoma and an IR according to LYRIC criteria, while the Higgins inconsistency index (I2) test and Cochran's Q test were used for heterogeneity. Eight original articles were included, in which the number of patients ranged from 7 to 243. Among the lymphoma patients with ICIs, the pooled incidence of pseudoprogression was 10% (95% confidence interval [CI]: 0.06-0.17). There was no publication bias in Begg's test ( = 0.14). Three articles were analyzed to determine the pooled incidence of pseudoprogression in patients with IR according to LYRIC criteria in a subgroup analysis, which was shown to be 19% (95% CI: 0.08-0.40). A significant proportion (10%) of patients with lymphoma treated with ICIs showed pseudoprogression, and 19% of patients with an IR response showed pseudoprogression and a delayed response. Immune-related response criteria such as LYRIC may be used for patients with lymphoma treated with ICIs.
PubMed: 34071024
DOI: 10.3390/jcm10112257