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Journal of Neuro-Oncology
Published in: Journal of Neuro-Oncology 1/2019

01-03-2019 | Clinical Study

Increase of pseudoprogression and other treatment related effects in low-grade glioma patients treated with proton radiation and temozolomide

Authors: Michael Dworkin, William Mehan, Andrzej Niemierko, Sophia C. Kamran, Nayan Lamba, Jorg Dietrich, Maria Martinez-Lage, Kevin S. Oh, Tracy T. Batchelor, Patrick Y. Wen, Jay S. Loeffler, Helen A. Shih

Published in: Journal of Neuro-Oncology | Issue 1/2019

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Abstract

Introduction

Concurrent radiotherapy and temozolomide (TMZ) is associated with radiographic pseudoprogression (PsP) in glioblastoma. The occurrence of PsP and other treatment effects is less well understood in low-grade gliomas (LGG). The purpose of this study is to evaluate whether the addition of TMZ to radiotherapy increases the incidence of PsP in adults with LGG treated with proton radiotherapy (PRT).

Methods

Chart review and volumetric MRI-analysis was performed on radiotherapy-naive adults with WHO grade II or IDH mutant WHO grade III gliomas treated with PRT between 2005 and 2015. Progression was defined by histology, new chemotherapy initiation, or progressive increase in lesion volume beyond 40% from baseline. Post treatment related effects (PTRE) were defined as new/increased T2/FLAIR or abnormal enhancement which eventually resolved or stabilized without evidence of progression for a period of 6–12 months. PsP was defined as the subset of PRTE suspicious for progression or volumetrically increased at least 40% from baseline. Pearson’s chi-squared test and Cox-proportional hazards models were used for statistical analysis.

Results

There were 119 patients meeting inclusion criteria. There was an increased risk of PsP following PRT + TMZ versus PRT-alone (HR = 2.2, p = 0.006, on Cox univariate analysis). Presence of PsP was associated with improved OS (p = 0.02 with PsP as time-varying covariate).

Conclusions

TMZ use, when added to PRT, was associated with increased PsP in patients with LGG; however, patients with PsP tended to achieve longer survival.
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Metadata
Title
Increase of pseudoprogression and other treatment related effects in low-grade glioma patients treated with proton radiation and temozolomide
Authors
Michael Dworkin
William Mehan
Andrzej Niemierko
Sophia C. Kamran
Nayan Lamba
Jorg Dietrich
Maria Martinez-Lage
Kevin S. Oh
Tracy T. Batchelor
Patrick Y. Wen
Jay S. Loeffler
Helen A. Shih
Publication date
01-03-2019
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 1/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-018-03063-1

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