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ECR 2019 / C-0185
Certificate of Merit
Neurooncology pending battles: is it possible to differentiate true progression from pseudoprogression?
Congress: ECR 2019
Poster No.: C-0185
Type: Educational Exhibit
Keywords: Neoplasia, Multidisciplinary cancer care, Radiation effects, Diagnostic procedure, MR-Diffusion/Perfusion, MR, Neuroradiology brain
Authors: A. Hilario Barrio, P. Martín Medina, E. Salvador, G. Ayala, L. Koren, A. Martinez de Aragon, F. Ballenilla, J. M. Millan, A. Ramos Gonzalez; Madrid/ES
DOI:10.26044/ecr2019/C-0185

Learning objectives

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.

 

Fig. 2: Brain tumor problems after 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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