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001024635 1001_ $$0P:(DE-Juel1)143792$$aGalldiks, Norbert$$b0
001024635 245__ $$aDiagnosing pseudoprogression in glioblastoma: A challenging clinical issue
001024635 260__ $$aOxford$$bOxford Univ. Press$$c2024
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001024635 520__ $$aPseudoprogression refers to the transient worsening of radiographic features on anatomical MRI after glioblastoma treatment, especially following radiotherapy combined with alkylating agents. This phenomenon mimics tumor progression, leading to misinterpretation and potentially premature adjustments to the ongoing treatment. Importantly, consequences of misinterpreting pseudoprogression may be profound. Patients may be subjected to unnecessary changes in treatment, including premature discontinuation of therapies that could potentially be beneficial or to overestimation of the efficacy of the subsequent therapy. Moreover, the emotional burden on patients and their families cannot be overstated.Distinguishing between actual tumor progression and pseudoprogression remains clinically challenging. More accurate diagnostic tools, such as positron emission tomography using radiolabeled amino acids1–3 and advanced MRI such as perfusion-weighted imaging,4 may add valuable additional diagnostic information in a considerable fraction of patients.In the study by Blakstad and colleagues recently published in Neuro-Oncology Practice,5 284 glioblastoma patients who underwent radiotherapy (100%) with concomitant (95%) and adjuvant temozolomide chemotherapy over ≤6 cycles (92%) and subsequent MRI follow-up scans were evaluated regarding the incidence and clinical significance of pseudoprogression using the Response Assessment in Neuro-Oncology Working Group criteria.6 Confirmation MRI scans during follow-up were used to verify the initial MRI findings post-radiation allowing, for example, the reclassification from progressive disease to pseudoprogression when follow-up MRI changes stabilized or regressed without change in treatmen
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