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Journal of Neuro-Oncology

, Volume 126, Issue 3, pp 559–566 | Cite as

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
  • Se Hoon Kim
  • Sung Soo Ahn
  • Seung Koo Lee
  • Hye Jin Choi
  • Jaeho Cho
  • Sun Ho Kim
  • Kyu-Sung Lee
  • Chang-Ok SuhEmail author
  • Jong Hee ChangEmail author
Clinical Study

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.

Keywords

Extent of resection Glioblastoma MGMT promoter status Pseudoprogression 

Notes

Acknowledgments

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2014R1A1A2058058).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Hun Ho Park
    • 1
    • 6
  • Tae Hoon Roh
    • 1
    • 6
  • Seok Gu Kang
    • 1
    • 6
    • 7
  • Eui Hyun Kim
    • 1
    • 6
    • 7
  • Chang-Ki Hong
    • 1
  • Se Hoon Kim
    • 2
    • 6
    • 7
  • Sung Soo Ahn
    • 3
    • 6
  • Seung Koo Lee
    • 3
    • 6
  • Hye Jin Choi
    • 4
    • 6
  • Jaeho Cho
    • 5
    • 6
  • Sun Ho Kim
    • 1
    • 6
    • 7
  • Kyu-Sung Lee
    • 1
    • 6
    • 7
  • Chang-Ok Suh
    • 5
    • 6
    • 8
    Email author
  • Jong Hee Chang
    • 1
    • 6
    • 7
    • 9
    Email author
  1. 1.Departments of NeurosurgeryYonsei University College of MedicineSeoulKorea
  2. 2.Departments of PathologyYonsei University College of MedicineSeoulKorea
  3. 3.Departments of RadiologyYonsei University College of MedicineSeoulKorea
  4. 4.Departments of Medical OncologyYonsei University College of MedicineSeoulKorea
  5. 5.Departments of Radiation OncologyYonsei University College of MedicineSeoulKorea
  6. 6.Brain Tumor CenterYonsei University College of MedicineSeoulKorea
  7. 7.Brain Research InstituteYonsei University College of MedicineSeoulKorea
  8. 8.Department of Radiation Oncology, Yonsei University Health SystemYonsei University College of MedicineSeoulKorea
  9. 9.Department of Neurosurgery, Yonsei University Health SystemYonsei University College of MedicineSeoulKorean

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