title: Spurious progression in pediatric brain tumors.
abstract: In this study, we sought to characterize post-therapy MRI changes mimicking progression, which we refer to as "spurious progression" (SP) in children with brain tumors. We analyzed whether SP is associated with particular tumor types or therapeutic modalities. Between 2000 and 2009, we identified 181 consecutive children <21 years of age at our center who were treated for brain tumors and had at least three MRI scans within a year after completing therapy. SP was defined as MRI abnormalities characterized by increase in size, enhancement, edema, or cystic changes within 12 months following therapy, and stabilization or improvement on subsequent imaging. One-hundred forty-one patients with brain tumors were evaluable. Fifty-six (40%) had imaging abnormalities initially suggestive of disease progression; of these, 34 (24%) had true disease progression (TP). The remaining 22 (16%) had SP based on either stability, decrease in enhancement, edema, size, or disappearance of these cystic or non-cystic abnormalities. SP occurred in patients with low grade (n = 20) and high grade lesions (n = 2). Median time to SP was 2.4 months (range, 0.7-8.3 months), with time to stability, decrease, or disappearance at a median of 4 months (range 1.4-7.7 months). Five patients were clinically symptomatic from SP and were treated with steroids, cyst drainage, and/or surgery. Therefore, SP occurs more commonly in children with low grade tumors, but can also occur with high grade brain tumors, regardless of therapeutic approach.
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave Box 647, Rochester, NY 14642, USA.
authors.forename: Sheema
authors.initials: S
authors.lastname: Chawla
authors.forename: David N
authors.initials: DN
authors.lastname: Korones
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Ali
authors.initials: A
authors.lastname: Hussain
authors.forename: Abdel R
authors.initials: AR
authors.lastname: Hussien
authors.forename: Ann G
authors.initials: AG
authors.lastname: Muhs
authors.forename: Manisha
authors.initials: M
authors.lastname: Mangla
authors.forename: Howard
authors.initials: H
authors.lastname: Silberstein
authors.forename: Sven
authors.initials: S
authors.lastname: Ekholm
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D001921:Brain / Q000187:drug effects* / Q000473:pathology* / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents