T2‐Fluid‐attenuated inversion recovery (FLAIR) pseudoprogression in patients with anaplastic oligodendrogliomas treated with procarbazine, lomustine and vincristine (PCV) chemotherapy alone

• Published in: European journal of neurology Vol. 30; no. 9; pp. 2879 - 2883
• Main Authors: Esparragosa Vazquez, Inés, Ndiaye, Mané, Di Stefano, Anna Luisa, Younan, Nadia, Larrieu‐Ciron, Delphine, Seyve, Antoine, Picart, Thiébaud, Meyronet, David, Boutet, Claire, Vassal, François, Carpentier, Catherine, Figarella‐Branger, Dominique, Dehais, Caroline, Forest, Fabien, Rivoirard, Romain, Ducray, François
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-09-2023; Wiley
• Subjects: anaplastic oligodendroglioma; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Blood volume; Brain cancer; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - drug therapy; Brain Neoplasms - pathology; Cerebral blood flow; Chemotherapy; Dihydroxyphenylalanine; Fluorine isotopes; Humans; Inversion; Levodopa; Life Sciences; Lomustine - adverse effects; Lomustine - therapeutic use; Magnetic Resonance Imaging; Medical imaging; Neoplasm Recurrence, Local; Oligodendroglioma; Oligodendroglioma - diagnostic imaging; Oligodendroglioma - drug therapy; Oligodendroglioma - surgery; PCV chemotherapy; Positron emission; Positron emission tomography; Procarbazine; Procarbazine - therapeutic use; pseudoprogression; Radiation therapy; radiotherapy; Recovery; Retrospective Studies; Substantia alba; Tumors; Vincristine; Vincristine - adverse effects; Vincristine - therapeutic use; pseudoprogression; radiotherapy; PCV chemotherapy; anaplastic oligodendroglioma
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15873

Background
Pseudoprogression in gliomas has been extensively described after radiotherapy with or without chemotherapy, but not after chemotherapy alone. Here we describe the occurrence of pseudoprogression in patients with anaplastic oligodendrogliomas treated with postoperative procarbazine, lomustine and vincristine (PCV) chemotherapy alone.
Methods
We retrospectively reviewed the medical and radiological files of patients with 1p/19q codeleted, IDH‐mutant anaplastic oligodendrogliomas treated with PCV chemotherapy alone who presented magnetic resonance imaging (MRI) modifications suggestive of tumour progression and in whom the final diagnosis was a pseudoprogression.
Results
We identified six patients. All patients underwent a surgical resection and were treated with PCV chemotherapy without radiotherapy. After a median of 11 months following the initiation of chemotherapy (range: 3–49 months), the patients developed asymptomatic white matter MRI modifications around the surgical cavity leading to the suspicion of a tumour progression. These modifications appeared as hyperintense on T2‐fluid‐attenuated inversion recovery (FLAIR) sequence, hypointense on T1 sequence, and lacked mass effect (0/6), contrast enhancement (0/6), restriction on diffusion‐weighted imaging (0/4), relative cerebral blood volume (rCBV) increase on perfusion MRI (0/4), and hypermetabolism on 18F‐fluoro‐L‐dopa positron emission tomography (18F‐DOPA PET) scan (0/3). One patient underwent a surgical resection demonstrating no tumour recurrence; the five other patients were considered as having post‐therapeutic modifications based on imaging characteristics. After a median follow‐up of 4 years all patients were progression‐free.
Conclusions
Anaplastic oligodendroglioma patients treated with postoperative PCV chemotherapy alone occasionally develop T2/FLAIR hyperintensities around the surgical cavity that can wrongly suggest tumour progression. Multimodal imaging and close follow‐up should be considered in this situation.