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Pseudoprogression in glioblastoma patients: the impact of extent of resection

Journal of Neuro-Oncology volume 126, pages 559–566 (2016)Cite this article

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.

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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).

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Authors and Affiliations

  1. Departments of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Hun Ho Park, Tae Hoon Roh, Seok Gu Kang, Eui Hyun Kim, Chang-Ki Hong, Sun Ho Kim, Kyu-Sung Lee & Jong Hee Chang

  2. Departments of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Se Hoon Kim

  3. Departments of Radiology, Yonsei University College of Medicine, Seoul, Korea

    Sung Soo Ahn & Seung Koo Lee

  4. Departments of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea

    Hye Jin Choi

  5. Departments of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea

    Jaeho Cho & Chang-Ok Suh

  6. Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea

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

  7. Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea

    Seok Gu Kang, Eui Hyun Kim, Se Hoon Kim, Sun Ho Kim, Kyu-Sung Lee & Jong Hee Chang

  8. Department of Radiation Oncology, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Chang-Ok Suh

  9. Department of Neurosurgery, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korean

    Jong Hee Chang

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  1. Hun Ho Park
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  2. Tae Hoon Roh
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  11. Sun Ho Kim
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Correspondence to Chang-Ok Suh or Jong Hee Chang.

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Park, H.H., Roh, T.H., Kang, S.G. et al. Pseudoprogression in glioblastoma patients: the impact of extent of resection. J Neurooncol 126, 559–566 (2016). https://doi.org/10.1007/s11060-015-2001-0

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Keywords

  • Extent of resection
  • Glioblastoma
  • MGMT promoter status
  • Pseudoprogression