Effect of adding temozolomide to radiation therapy on the incidence of pseudo-progression
Effect of adding temozolomide to radiation therapy on the incidence of pseudo-progression
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DOI：
10.1007/s11060-009-9809-4
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发表时间：
2009-08-01
影响因子：
3.9
通讯作者：
Wen, Patrick Y.
中科院分区：
文献类型：
--
作者：
Gerstner, Elizabeth R.;McNamara, Margaret B.;Wen, Patrick Y.
最近，人们越来越意识到，联合放疗和替莫唑胺用于治疗胶质母细胞瘤可能会导致放射后首次MRI扫描的对比度增强。然而，这种增强可能会随着时间的推移而稳定或降低，并代表假性进展（psPD）而不是真正的疾病进展。从未有证据表明，联合治疗的这种现象比单独放疗更严重。为了解决这个问题，我们回顾了单独接受放射治疗的胶质母细胞瘤患者与接受放射治疗和伴随替莫唑胺治疗的患者的MRI扫描，并比较了两组中psPD的频率。47例仅接受放疗的患者中有18例（38%）在首次放疗后MRI扫描时显示增大，其中11例（61%）证实患有psPD，定义为放疗后3个月稳定治疗后无进一步增大。45例接受放疗和替莫唑胺治疗的患者中有24例（53%）在首次放疗后MRI扫描时出现了肿大，其中13例（54%）患有psPD。单纯放射治疗的psPD患者的中位总生存期（OS）为15.6个月，而未接受psPD治疗的患者为12.8个月。接受放疗和伴随替莫唑胺治疗的psPD患者的中位OS为24.4个月，而未患psPD的患者为15.9个月。我们无法检测到四组之间OS的差异。与治疗无关的psPD的存在与延长的无进展生存期相关（P = 0.05），但与OS无关。psPD在联合治疗中可能更常见，但最有可能是小幅度的。
Recently, there has been greater awareness that combination radiation and temozolomide used to treat glioblastomas may cause increased contrast enhancement on the first post radiation MRI scan. However, this increased enhancement may stabilize or decrease over time and represent pseudo-progression (psPD) rather than true progressive disease. It has never been shown that this phenomenon is greater with combination therapy than radiation alone. To address this question, we reviewed MRI scans in glioblastoma patients treated with radiation alone versus patients treated with radiation and concomitant temozolomide and compared the frequency of psPD in the two groups. Eighteen of 47 patients (38%) treated with radiation alone demonstrated enlargement on their first post-radiation MRI scan and 11 of these 18 (61%) proved to have psPD as defined by no further enlargement on stable therapy for 3 months following radiation. Twenty-four of 45 patients (53%) treated with radiation and temozolomide had enlargement on their first post-radiation MRI scan and 13 of these 24 (54%) had psPD. Median overall survival (OS) in patients with psPD treated with radiation alone was 15.6 versus 12.8 months in those without psPD. Median OS in patients treated with radiation and concomitant temozolomide who had psPD was 24.4 versus 15.9 months in those who did not have psPD. We were unable to detect a difference in OS between the four groups. Presence of psPD, independent of treatment, was associated with prolonged progression-free survival (P = 0.05) but not OS. psPD may be more common in combination therapy but most likely by a small margin.