T2-Fluid-attenuated inversion recovery (FLAIR) pseudoprogression in patients with anaplastic oligodendrogliomas treated with procarbazine, lomustine and vincristine (PCV) chemotherapy alone.

Autor: Esparragosa Vazquez I; Neuro-Oncology Department, Hospices Civils of Lyon, Lyon, France., Ndiaye M; Neuro-Oncology Department, Centre Georges François Leclerc, Dijon, France., Di Stefano AL; Neuro-Oncology Department, Hôpital Foch, Suresnes, France., Younan N; Neuro-Oncology Department, Hôpital Foch, Suresnes, France., Larrieu-Ciron D; Neuro-Oncology Department, Institut Universitaire du Cancer de Toulouse, Toulouse, France., Seyve A; Neuro-Oncology Department, Hospices Civils of Lyon, Lyon, France., Picart T; Neuro-Surgery Department, Hospices Civils of Lyon, Lyon, France., Meyronet D; Neuropathology Department, Hospices Civils of Lyon, Lyon, France.; Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France., Boutet C; Radiology Department, University Hospital of St-Etienne, St-Etienne, France., Vassal F; Neuro-Surgery Department, University Hospital of St-Etienne, St-Etienne, France., Carpentier C; Department of Neurology 2-Mazarin, APHP, University Hospital Pitié Salpêtrière-Charles Foix, Paris, France., Figarella-Branger D; Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille University, Marseille, France., Dehais C; Department of Neurology 2-Mazarin, APHP, University Hospital Pitié Salpêtrière-Charles Foix, Paris, France., Forest F; Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France., Rivoirard R; Oncology Department, Hôpital Privé de la Loire, Saint Etienne, France., Ducray F; Neuro-Oncology Department, Hospices Civils of Lyon, Lyon, France.; Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2023 Sep; Vol. 30 (9), pp. 2879-2883. Date of Electronic Publication: 2023 May 31.
DOI: 10.1111/ene.15873
Abstrakt: Background: Pseudoprogression in gliomas has been extensively described after radiotherapy with or without chemotherapy, but not after chemotherapy alone. Here we describe the occurrence of pseudoprogression in patients with anaplastic oligodendrogliomas treated with postoperative procarbazine, lomustine and vincristine (PCV) chemotherapy alone.
Methods: We retrospectively reviewed the medical and radiological files of patients with 1p/19q codeleted, IDH-mutant anaplastic oligodendrogliomas treated with PCV chemotherapy alone who presented magnetic resonance imaging (MRI) modifications suggestive of tumour progression and in whom the final diagnosis was a pseudoprogression.
Results: We identified six patients. All patients underwent a surgical resection and were treated with PCV chemotherapy without radiotherapy. After a median of 11 months following the initiation of chemotherapy (range: 3-49 months), the patients developed asymptomatic white matter MRI modifications around the surgical cavity leading to the suspicion of a tumour progression. These modifications appeared as hyperintense on T2-fluid-attenuated inversion recovery (FLAIR) sequence, hypointense on T1 sequence, and lacked mass effect (0/6), contrast enhancement (0/6), restriction on diffusion-weighted imaging (0/4), relative cerebral blood volume (rCBV) increase on perfusion MRI (0/4), and hypermetabolism on 18 F-fluoro-L-dopa positron emission tomography ( 18 F-DOPA PET) scan (0/3). One patient underwent a surgical resection demonstrating no tumour recurrence; the five other patients were considered as having post-therapeutic modifications based on imaging characteristics. After a median follow-up of 4 years all patients were progression-free.
Conclusions: Anaplastic oligodendroglioma patients treated with postoperative PCV chemotherapy alone occasionally develop T2/FLAIR hyperintensities around the surgical cavity that can wrongly suggest tumour progression. Multimodal imaging and close follow-up should be considered in this situation.
(© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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