|ECR 2019 / C-0185||
|Neurooncology pending battles: is it possible to differentiate true progression from pseudoprogression?|
Glioblastoma is the most common primary malignant brain tumor in adults and it is associated with a dismal prognosis (median survival time of patients only 3 to 9 months after first recurrence).
Current standard of care is STUPP scheme: surgical resection followed by radiotherapy (RT) and concomitant and adjuvant temozolomide (TMZ) chemotherapy.
What are the main problems of brain tumors?
- Infiltrating tumors, indistinct borders
- Difficult to differentiate tumor infiltration, edema, gliosis and post-RT changes
- Enhancement only reflects blood brain barrier (BBB) permeability
- Problems to distinguish recurrence from post-treatment changes
- New treatments produce new imaging patterns: pseudoprogression (Rt+QT, immunotherapies...) similar to true progression
Hence, Response Assessment in Neuro-Oncology Working Group (RANO) emerged in an attemp to provide standarized response criteria that accounts for transient changes in tumor volume post-therapy.
References: Radiology, Hospital Universitario 12 de Octubre, 12 Octubre - Madrid/ES
Our objectives were to decribe tips and tricks at MRI that help us differentiate true progression (TP) from pseudoprogression (PsP) in the follow-up of treated gliomas.
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