title: High levels of cellular proliferation predict pseudoprogression in glioblastoma             patients.
abstract: Radiochemotherapy (RT) with concomitant followed by monthly temozolomide             (TMZ) chemotherapy is the gold standard for the treatment of glioblastoma (GBM)             patients. GBM patients can experience transient radiological deterioration after             concurrent RT/TMZ that stabilizes or even resolves after additional cycles of             adjuvant TMZ, a phenomenon defined as radiological pseudoprogression. The aim             of this retrospective study was to identify a reliable marker associated with             pseudoprogression processes. Patients with histologically proven newly diagnosed             GBM were identified from a retrospective database between 2005 and 2009. Predictive             factors for pseudoprogression were analyzed from clinical, radiological and biological             data. Of the 130 analyzed patients, 63 underwent RT/TMZ treatment followed by             cycles of TMZ and were evaluated for radiological responses every two months by             magnetic resonance imaging. Early progression was confirmed in 52% (33/63) of             the patients, and, within this group, 21% (7/33) displayed evidence of pseudo-progression.             The predictive factors were evidenced in terms of clinical or radiological findings.             In GBM patients, the level of cellular proliferation (Ki67 indices) emerged as             a statistically significant prognostic marker for distinguishing pseudoprogression             from actual progression. Our observation, suggesting that GBM associated with             a high level of cellular proliferation may differentiate tumor progression from             pseudoprogression, warrants further investigation in a large multi-center prospective             study.
authors.affiliation: Department of Neurosurgery, Hôpital Erasme, Brussels, Belgium.
authors.forename: Henri-Benjamin
authors.initials: HB
authors.lastname: Pouleau
authors.forename: Niloufar
authors.initials: N
authors.lastname: Sadeghi
authors.forename: Danielle
authors.initials: D
authors.lastname: Balériaux
authors.forename: Christian
authors.initials: C
authors.lastname: Mélot
authors.forename: Olivier
authors.initials: O
authors.lastname: De Witte
authors.forename: Florence
authors.initials: F
authors.lastname: Lefranc
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D048708:Cell Growth Processes / Q000502:physiology; D059248:Chemoradiotherapy; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
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