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Tumor progression is a phenomenon where the pre-formed tumor acquires successive mutations to become clinically more aggressive and malignant. In the 1950s, Foulds first described the stepwise progression of cancer cells through successive stages.
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Pseudoprogression in high-grade glioma.

K M Knudsen-Baas1, G Moen, Ø Fluge

  • 1Department of Neurology, Haukeland University Hospital, Bergen, Norway. kristin.marie.knudsen-baas@helse-bergen.no

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Pseudoprogression, a common imaging effect in high-grade glioma, can mimic tumor recurrence. Careful MRI interpretation is crucial in the first six months post-treatment to avoid unnecessary therapy changes.

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Area of Science:

  • Neuro-oncology
  • Radiology
  • Oncologic Imaging

Background:

  • Pseudoprogression is a treatment effect in high-grade glioma, often seen after radiotherapy with temozolomide (TMZ) for glioblastoma multiforme (GBM).
  • It presents as contrast enhancement on MRI, mimicking tumor recurrence or radiation necrosis.

Observation:

  • Standard MRI with gadolinium contrast cannot reliably differentiate pseudoprogression from true tumor progression or radiation necrosis.
  • Medullary pseudoprogression is a rare subentity with limited reported literature.
  • Pseudoprogression may be linked to the methylated O(6)-methyl-guanine methyl transferase (MGMT) gene promoter, indicating a positive treatment response.

Findings:

  • Misinterpreting pseudoprogression as disease progression can lead to premature discontinuation or alteration of effective therapy.
  • Advanced imaging techniques for differentiation are not always accessible.

Implications:

  • MRI interpretation in high-grade glioma patients requires caution during the initial six months post-treatment.
  • For GBM patients with contrast enhancement but stable clinical status, continuing treatment and scheduling follow-up imaging in 2-3 months is recommended.