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Incidence and Characteristics of Pseudoprogression in IDH-mutant High-Grade Gliomas: A POLA Network Study.

Antoine Seyve 1 Caroline Dehais 2, 3 Olivier Chinot 4, 5 Apolline Djelad Elisabeth Cohen-Moyal Charlotte Bronnimann 6 Carole Gourmelon 7 Evelyne Emery 8 Philippe Colin 9 Mathieu Boone 10, 11 Elodie Vauléon 12, 13 Olivier Langlois 14 Anna-Luisa Di Stefano Romuald Seizeur 15, 16 François Ghiringhelli 17 Anne d'Hombres Loic Feuvret 18 Jacques Guyotat 19 Laurent Capelle 20 Catherine Carpentier 2, 20 Louis Garnier Jérôme Honnorat 21, 22 David Meyronet 19 Karima Mokhtari 2, 20, 23 Dominique Figarella-Branger 4 François Ducray 24 
Abstract : BACKGROUND: Incidence and characteristics of pseudoprogression in isocitrate dehydrogenase-mutant high-grade gliomas (IDHmt HGG) remain to be specifically described. METHODS: We analyzed pseudoprogression characteristics and explored the possibility of pseudoprogression misdiagnosis in IDHmt HGG patients, treated with radiotherapy (with or without chemotherapy), included in the French POLA network. Pseudoprogression was analyzed in patients with MRI available for review (reference cohort, n=200). Pseudoprogression misdiagnosis was estimated in this cohort and in an independent cohort (control cohort, n=543) based on progression free survival before and after first progression. RESULTS: In the reference cohort, 38 patients (19%) presented a pseudoprogression after a median time of 10.5 months after radiotherapy. Pseudoprogression characteristics were similar across IDHmt HGG subtypes. In most patients, it consisted in the appearance of one or several infracentimetric, asymptomatic, contrast-enhanced lesions occurring within 2 years after radiotherapy. The only factor associated with pseudoprogression occurrence was adjuvant PCV chemotherapy. Among patients considered as having a first true progression, 7 out of 41 (17%) in the reference cohort and 35 out of 203 (17%) in the control cohort were retrospectively suspected to have a misdiagnosed pseudoprogression. Patients with a misdiagnosed pseudoprogression were characterized by a time to event and an outcome similar to that of patients with a pseudoprogression but presented with larger and more symptomatic lesions. CONCLUSION: In patients with an IDHmt HGG, pseudoprogression occurs later than in IDH-wildtype glioblastomas and seems not only frequent but also frequently misdiagnosed. Within the first 2 years after radiotherapy, the possibility of a pseudoprogression should be carefully considered.
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Soumis le : jeudi 18 août 2022 - 16:19:24
Dernière modification le : samedi 3 septembre 2022 - 03:33:10

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Antoine Seyve, Caroline Dehais, Olivier Chinot, Apolline Djelad, Elisabeth Cohen-Moyal, et al.. Incidence and Characteristics of Pseudoprogression in IDH-mutant High-Grade Gliomas: A POLA Network Study.. Neuro-Oncology, Oxford University Press (OUP), 2022, pp.noac194. ⟨10.1093/neuonc/noac194⟩. ⟨hal-03753737⟩

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