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J Neurooncol. 2016 Aug;129(1):109-21. doi: 10.1007/s11060-016-2151-8. Epub 2016 May 14.

Pseudoprogression in children, adolescents and young adults with non-brainstem high grade glioma and diffuse intrinsic pontine glioma.

Author information

1
Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK. fernando.carceller@icr.ac.uk.
2
Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK. fernando.carceller@icr.ac.uk.
3
Department of Radiology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
4
Research Data Management and Statistics Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
5
Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
6
Division of Clinical Studies and Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.
7
Clinical Research Unit - Pediatric Phase I-II Clinical Trials, Pediatric Oncology-Hematology Service, Hospital Niño Jesús, Av. de Menéndez Pelayo, num 65, 28009, Madrid, Spain.
8
Department of Neuro Oncology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
9
Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.
10
Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69121, Heidelberg, Germany.
11
Division of Molecular Genetics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69121, Heidelberg, Germany.
12
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
13
CRUK Cancer Imaging Centre, Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.
14
Department of Cellular Pathology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
15
Department of Clinical Neuropathology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
16
Department of Pediatric Oncology and Hematology, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.

Abstract

Pseudoprogression (PsP) is a treatment-related phenomenon which hinders response interpretation. Its prevalence and clinical impact have not been evaluated in children/adolescents. We assessed the characteristics, risk factors and prognosis of PsP in children/adolescents and young-adults diagnosed with non-brainstem high grade gliomas (HGG) and diffuse intrinsic pontine gliomas (DIPG). Patients aged 1-21 years diagnosed with HGG or DIPG between 1995 and 2012 who had completed radiotherapy were eligible. PsP was assessed according to study-specific criteria and correlated with first-line treatment, molecular biomarkers and survival. Ninety-one patients (47 HGG, 44 DIPG) were evaluable. Median age: 10 years (range, 2-20). Eleven episodes of PsP were observed in 10 patients (4 HGG, 6 DIPG). Rates of PsP: 8.5 % (HGG); 13.6 % (DIPG). Two episodes of PsP were based on clinical findings alone; nine episodes had concurrent radiological changes: increased size of lesions (n = 5), new focal enhancement (n = 4). Temozolomide, MGMT methylation or H3F3A mutations were not found to be associated with increased occurrence of PsP. For HGG, 1-year progression-free survival (PFS) was 41.9 % no-PsP versus 100 % PsP (p = 0.041); differences in 1-year overall survival (OS) were not significant. For DIPG, differences in 1-year PFS and OS were not statistically significant. Hazard ratio (95 %CI) of PsP for OS was 0.551 (0.168-1.803; p = 0.325) in HGG; and 0.308 (0.107-0.882; p = 0.028) in DIPG. PsP occurred in both pediatric HGG and DIPG patients at a comparable rate to adult HGG. PsP was associated with improved 1-yr PFS in HGG patients. PsP had a protective effect upon OS in DIPG patients.

KEYWORDS:

Brain tumors; Childhood; Children; Diffuse intrinsic pontine glioma; High grade glioma; Pseudoprogression

PMID:
27180091
DOI:
10.1007/s11060-016-2151-8
[Indexed for MEDLINE]

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