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Contrast enhancing spots as a new pattern of late onset pseudoprogression in glioma patients

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Abstract

Introduction

Magnet resonance imaging (MRI) of gliomas is assessed by Response Assessment in Neuro-Oncology Criteria (RANO), which define new contrast-enhancing lesions as a sign for tumor recurrence. Pseudoprogression after radiotherapy may mimic tumor progression in MRI but is usually limited to the first months after irradiation. We noted a late onset pattern of new contrast-enhancing spots (NCES) appearing years after radiotherapy.

Methods

We prospectively collected 23 glioma patients with 26 NCES (three patients had two separate NCES events) between 2014 and 2016 in our weekly tumor board without further selection by diagnosis, molecular markers or pretreatment.

Results

Retrospective analysis revealed a homogeneous collective of young patients (median age of 49 years at NCES) with mainly IDH-mutated glioma (61%). Initial histology showed 26% glioblastoma, 52% grade III and 22% grade II glioma. NCES occurred at late follow-up with a median of 52 months after tumor diagnosis and 30 months after the last radiotherapy. The majority of NCES regressed spontaneously within a median of 10 months (n = 11) or remained stable without further therapy with a median follow-up of 26 months (n = 7). Only 4 NCES developed MRI morphologically into tumor recurrence. Two NCES were resected without any histopathological proof of tumor recurrence, and in 2 other cases NCES were defined as ischemic stroke or radionecrosis.

Conclusion

We hypothesize that the late onset phenomenon of NCES predominantly represents a form of radiation-induced vasculopathy that is different from early pseudoprogression and should be considered especially in younger patients with IDH-mutated glioma before initiation of new therapy.

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Acknowledgements

The Senckenberg Institute of Neurooncology is supported by the Senckenberg Foundation.

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Author notes

  1. Marlies Wagner and Stella Breuer have contributed equally to this work.

Authors and Affiliations

  1. Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Martin Voss & Joachim P. Steinbach

  2. Departement of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

    Kea Franz & Marie-Thérèse Forster

  3. Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

    Emmanouil Fokas

  4. Institut of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

    Katharina Filipski

  5. Departement of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

    Elke Hattingen, Marlies Wagner & Stella Breuer

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  1. Martin Voss
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Correspondence to Martin Voss.

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This study has been accepted by the local ethics committee (SNO_SNO_01–08).

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Voss, M., Franz, K., Steinbach, J.P. et al. Contrast enhancing spots as a new pattern of late onset pseudoprogression in glioma patients. J Neurooncol 142, 161–169 (2019). https://doi.org/10.1007/s11060-018-03076-w

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