Incidence and characteristics of pseudoprogression in IDH-mutant high-grade gliomas: A POLA network study. Issue 3 (12th August 2022)

• Record Type: Journal Article
• Authors: Seyve, Antoine; Dehais, Caroline; Chinot, Olivier; Djelad, Apolline; Cohen-Moyal, Elisabeth; Bronnimann, Charlotte; Gourmelon, Carole; Emery, Evelyne; Colin, Philippe; Boone, Mathieu; Vauléon, Elodie; Langlois, Olivier; di Stefano, Anna-Luisa; Seizeur, Romuald; Ghiringhelli, François; D'Hombres, Anne; Feuvret, Loic; Guyotat, Jacques; Capelle, Laurent; Carpentier, Catherine; Garnier, Louis; Honnorat, Jérôme; Meyronet, David; Mokhtari, Karima; Figarella-Branger, Dominique; Ducray, François
• Is Part Of: Neuro-oncology. Volume 25:Issue 3(2023)
• Page Start: 495
• Page End: 507
• Publication Date: 2022-08-12
• Subjects: chemotherapy -- high-grade glioma -- IDH-mutant -- pseudoprogression -- radiotherapy; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noac194
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: Incidence and characteristics of pseudoprogression in isocitrate dehydrogenase-mutant high-grade gliomas (IDHmt HGG) remain to be specifically described. Methods: We analyzed pseudoprogression characteristics and explored the possibility of pseudoprogression misdiagnosis in IDHmt HGG patients, treated with radiotherapy (RT) (with or without chemotherapy [CT]), included in the French POLA network. Pseudoprogression was analyzed in patients with MRI available for review (reference cohort, n = 200). Pseudoprogression misdiagnosis was estimated in this cohort and in an independent cohort (control cohort, n = 543) based on progression-free survival before and after first progression. Results: In the reference cohort, 38 patients (19%) presented a pseudoprogression after a median time of 10.5 months after RT. Pseudoprogression characteristics were similar across IDHmt HGG subtypes. In most patients, it consisted of the appearance of one or several infracentimetric, asymptomatic, contrast-enhanced lesions occurring within 2 years after RT. The only factor associated with pseudoprogression occurrence was adjuvant PCV CT. Among patients considered as having a first true progression, 7 out of 41 (17%) in the reference cohort and 35 out of 203 (17%) in the control cohort were retrospectively suspected to have a misdiagnosed pseudoprogression. Patients with a misdiagnosed pseudoprogression were characterized by a time to event and an outcome similar to that of patients with a pseudoprogression but presented with larger and more symptomatic lesions. Conclusion: In patients with an IDHmt HGG, pseudoprogression occurs later than in IDH-wildtype glioblastomas and seems not only frequent but also frequently misdiagnosed. Within the first 2 years after RT, the possibility of a pseudoprogression should be carefully considered.