Zeyen, Thomas and Paech, Daniel and Weller, Johannes and Schaefer, Niklas and Tzaridis, Theophilos and Duffy, Cathrina and Nitsch, Louisa and Schneider, Matthias and Potthoff, Anna-Laura and Steinbach, Joachim Peter and Hau, Peter and Schlegel, Uwe and Seidel, Clemens and Krex, Dietmar and Grauer, Oliver and Goldbrunner, Roland and Zeiner, Pia Susan and Tabatabai, Ghazaleh and Galldiks, Norbert and Stummer, Walter and Hattingen, Elke and Glas, Martin and Radbruch, Alexander and Herrlinger, Ulrich and Schaub, Christina (2023) Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses. JOURNAL OF NEURO-ONCOLOGY, 164 (3). pp. 607-616. ISSN 0167-594X, 1573-7373
Full text not available from this repository. (Request a copy)Abstract
Purpose In the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO).Methods We classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T1-enhancing, FLAIR hyperintense lesion volume and the change in ADC mean value of contrast-enhancing tumor upon progression were determined.Results Patients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T1-enhancement (p = 0.22) as compared to long PPS patients of the TMZ arm.Conclusion The combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | NEWLY-DIAGNOSED GLIOBLASTOMA; RESPONSE ASSESSMENT; PROGRESSION; THERAPY; TEMOZOLOMIDE; CHALLENGES; LOMUSTINE; Glioblastoma; MGMT promotor methylation; Progression; Pseudoprogression; MRI |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Jan 2024 13:07 |
| Last Modified: | 30 Jan 2024 13:07 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60846 |
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