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Zeyen, Thomas [Author]; Paech, Daniel [Author]; Hau, Peter [Author]; Schlegel, Uwe [Author]; Seidel, Clemens [Author]; Krex, Dietmar [Author]; Grauer, Oliver [Author]; Goldbrunner, Roland [Author]; Zeiner, Pia Susan [Author]; Tabatabai, Ghazaleh [Author]; Galldiks, Norbert [Author]; Stummer, Walter [Author]; Weller, Johannes [Author]; Hattingen, Elke [Author]; Glas, Martin [Author]; Radbruch, Alexander [Author]; Herrlinger, Ulrich [Author]; Schaub, Christina [Author]; Schäfer, Niklas [Author]; Tzaridis, Theophilos [Author]; Duffy, Cathrina [Author]; Nitsch, Louisa [Author]; Schneider, Matthias [Author]; Potthoff, Anna-Laura [Author];

Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses

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  • Media type: E-Article
  • Title: Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses
  • Contributor: Zeyen, Thomas [Author]; Paech, Daniel [Author]; Hau, Peter [Author]; Schlegel, Uwe [Author]; Seidel, Clemens [Author]; Krex, Dietmar [Author]; Grauer, Oliver [Author]; Goldbrunner, Roland [Author]; Zeiner, Pia Susan [Author]; Tabatabai, Ghazaleh [Author]; Galldiks, Norbert [Author]; Stummer, Walter [Author]; Weller, Johannes [Author]; Hattingen, Elke [Author]; Glas, Martin [Author]; Radbruch, Alexander [Author]; Herrlinger, Ulrich [Author]; Schaub, Christina [Author]; Schäfer, Niklas [Author]; Tzaridis, Theophilos [Author]; Duffy, Cathrina [Author]; Nitsch, Louisa [Author]; Schneider, Matthias [Author]; Potthoff, Anna-Laura [Author];
  • imprint: Springer Science + Business Media B.V, 2023
  • Published in: Journal of neuro-oncology 164(3), 607 - 616 (2023). doi:10.1007/s11060-023-04444-x
  • Language: English
  • DOI: https://doi.org/10.1007/s11060-023-04444-x; https://doi.org/10.34734/FZJ-2023-04876
  • ISSN: 1573-7373; 0167-594X
  • Origination:
  • Footnote: Diese Datenquelle enthält auch Bestandsnachweise, die nicht zu einem Volltext führen.
  • Description: Purpose: In the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO).Methods: We classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T1-enhancing, FLAIR hyperintense lesion volume and the change in ADC mean value of contrast-enhancing tumor upon progression were determined.Results: Patients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T1-enhancement (p = 0.22) as compared to long PPS patients of the TMZ arm.Conclusion: The combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.Keywords: Glioblastoma; MGMT promotor methylation; MRI; Progression; Pseudoprogression.
  • Access State: Open Access