Pseudoprogression in glioblastoma patients: the impact of extent of resection

Hun Ho Park, Tae Hoon Roh, Seok-Gu Kang, Eui Hyun Kim, Chang Ki Hong, SeHoon Kim, Sung Soo Ahn, Seung Koo Lee, Hye Jin Choi, Jaeho Cho, Sun Ho Kim, Kyu Sung Lee, Chang-Ok Suh, Jong Hee Chang

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Abstract

Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4 %), 34 (33.7 %), 9 (8.9 %) and 1 patient (1 %), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6 %) as psPD and 56 (55.4 %) as non-psPD. psPD was observed in 24 (61.5 %) of 39 patients with methylated MGMT promoter and 21 (33.9 %) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8 %), 19 (55.9 %), 8 (88.9 %) and 1 (100 %) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95 % CI 1.36–8.34) and EOR (OR 4.12, 95 % CI 1.71–9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival.

Original languageEnglish
Pages (from-to)559-566
Number of pages8
JournalJournal of Neuro-Oncology
Volume126
Issue number3
DOIs
Publication statusPublished - 2016 Feb 1

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Glioblastoma
Biopsy
Survival
Proportional Hazards Models
Methylation
Multivariate Analysis
Radiation

All Science Journal Classification (ASJC) codes

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Park, Hun Ho ; Roh, Tae Hoon ; Kang, Seok-Gu ; Kim, Eui Hyun ; Hong, Chang Ki ; Kim, SeHoon ; Ahn, Sung Soo ; Lee, Seung Koo ; Choi, Hye Jin ; Cho, Jaeho ; Kim, Sun Ho ; Lee, Kyu Sung ; Suh, Chang-Ok ; Chang, Jong Hee. / Pseudoprogression in glioblastoma patients : the impact of extent of resection. In: Journal of Neuro-Oncology. 2016 ; Vol. 126, No. 3. pp. 559-566.
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title = "Pseudoprogression in glioblastoma patients: the impact of extent of resection",
abstract = "Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4 {\%}), 34 (33.7 {\%}), 9 (8.9 {\%}) and 1 patient (1 {\%}), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6 {\%}) as psPD and 56 (55.4 {\%}) as non-psPD. psPD was observed in 24 (61.5 {\%}) of 39 patients with methylated MGMT promoter and 21 (33.9 {\%}) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8 {\%}), 19 (55.9 {\%}), 8 (88.9 {\%}) and 1 (100 {\%}) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95 {\%} CI 1.36–8.34) and EOR (OR 4.12, 95 {\%} CI 1.71–9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival.",
author = "Park, {Hun Ho} and Roh, {Tae Hoon} and Seok-Gu Kang and Kim, {Eui Hyun} and Hong, {Chang Ki} and SeHoon Kim and Ahn, {Sung Soo} and Lee, {Seung Koo} and Choi, {Hye Jin} and Jaeho Cho and Kim, {Sun Ho} and Lee, {Kyu Sung} and Chang-Ok Suh and Chang, {Jong Hee}",
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Park, HH, Roh, TH, Kang, S-G, Kim, EH, Hong, CK, Kim, S, Ahn, SS, Lee, SK, Choi, HJ, Cho, J, Kim, SH, Lee, KS, Suh, C-O & Chang, JH 2016, 'Pseudoprogression in glioblastoma patients: the impact of extent of resection', Journal of Neuro-Oncology, vol. 126, no. 3, pp. 559-566. https://doi.org/10.1007/s11060-015-2001-0

Pseudoprogression in glioblastoma patients : the impact of extent of resection. / Park, Hun Ho; Roh, Tae Hoon; Kang, Seok-Gu; Kim, Eui Hyun; Hong, Chang Ki; Kim, SeHoon; Ahn, Sung Soo; Lee, Seung Koo; Choi, Hye Jin; Cho, Jaeho; Kim, Sun Ho; Lee, Kyu Sung; Suh, Chang-Ok; Chang, Jong Hee.

In: Journal of Neuro-Oncology, Vol. 126, No. 3, 01.02.2016, p. 559-566.

Research output: Contribution to journalArticle

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T1 - Pseudoprogression in glioblastoma patients

T2 - the impact of extent of resection

AU - Park, Hun Ho

AU - Roh, Tae Hoon

AU - Kang, Seok-Gu

AU - Kim, Eui Hyun

AU - Hong, Chang Ki

AU - Kim, SeHoon

AU - Ahn, Sung Soo

AU - Lee, Seung Koo

AU - Choi, Hye Jin

AU - Cho, Jaeho

AU - Kim, Sun Ho

AU - Lee, Kyu Sung

AU - Suh, Chang-Ok

AU - Chang, Jong Hee

PY - 2016/2/1

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N2 - Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4 %), 34 (33.7 %), 9 (8.9 %) and 1 patient (1 %), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6 %) as psPD and 56 (55.4 %) as non-psPD. psPD was observed in 24 (61.5 %) of 39 patients with methylated MGMT promoter and 21 (33.9 %) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8 %), 19 (55.9 %), 8 (88.9 %) and 1 (100 %) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95 % CI 1.36–8.34) and EOR (OR 4.12, 95 % CI 1.71–9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival.

AB - Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4 %), 34 (33.7 %), 9 (8.9 %) and 1 patient (1 %), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6 %) as psPD and 56 (55.4 %) as non-psPD. psPD was observed in 24 (61.5 %) of 39 patients with methylated MGMT promoter and 21 (33.9 %) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8 %), 19 (55.9 %), 8 (88.9 %) and 1 (100 %) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95 % CI 1.36–8.34) and EOR (OR 4.12, 95 % CI 1.71–9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival.

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