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. 2016 Dec;130(3):529-533.
doi: 10.1007/s11060-016-2247-1. Epub 2016 Oct 4.

Molecular and histologic characteristics of pseudoprogression in diffuse gliomas

Andrew L Lin  1   2 , Michael White  1 , Michelle M Miller-Thomas  3 , Robert S Fulton  4 , Christina I Tsien  5 , Keith M Rich  6 , Robert E Schmidt  7 , David D Tran  8   9 , Sonika Dahiya  10
Affiliations

Molecular and histologic characteristics of pseudoprogression in diffuse gliomas

Andrew L Lin et al. J Neurooncol. 2016 Dec.

Abstract

During the 6 month period following chemoradiotherapy, gliomas frequently develop new areas of contrast enhancement, which are due to treatment effect rather than tumor progression. We sought to characterize this phenomenon in oligodendrogliomas (OG) and mixed oligoastrocytomas (MOA). We reviewed the imaging findings from 143 patients with a WHO grade II or III OG or MOA for evidence of pseudoprogression (PsP) or early tumor progression. We characterized these cases for 1p/19q codeletions by FISH, IDH1 R132H mutation by immunohistochemistry, and TP53, ATRX, and EGFR mutations by next generation sequencing. We then reviewed the pathologic specimens of the patient cases in which a re-resection was performed. We found that OG and MOA that are 1p/19q intact developed PsP at a higher rate than tumors that are 1p/19q codeleted (27 vs. 8 %). Moreover, IDH1 wild-type (WT) tumors developed PsP at a higher rate than IDH1 R132H cases (27 vs. 11 %). Patients with ATRX or TP53 mutations developed PsP at an intermediate rate of 21 %. Ten patients in our cohort underwent a re-resection for early contrast enhancement; these tumors were predominantly 1p/19q intact (90 %) and had a low rate of IDH1 R132H mutation (50 %). 8 of 10 tumors demonstrated primarily treatment effects, while the remaining 2 of 10 demonstrated recurrent/residual tumor of the same grade. Early contrast enhancement that develops during the first 6 months after chemoradiotherapy is typically due to PsP and occurs primarily in OG and MOA that are 1p/19q intact and IDH WT.

Keywords: Astrocytoma; Diffuse glioma; Mixed oligoastrocytoma; Oligodendroglioma; Pseudoprogression; Radiation necrosis.

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Conflict of interest statement

Conflict of interest: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Prevalence of PsP and early progression by WHO grade: (a) grade II and (b) grade III
Figure 2
Figure 2
Rate of PsP and early progression by molecular characteristics
Figure 3
Figure 3
RT-related changes in patients with second-look resections for early contrast enhancement (first 6 months after RT)
See this image and copyright information in PMC

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