Evidence map›Paper›PMID 25038253›Full record

ArticleNeuro-oncology2015

Pseudoprogression in patients with glioblastoma: clinical relevance despite low incidence.

Alexander Radbruch, Joachim Fladt, Philipp Kickingereder, Benedikt Wiestler, Martha Nowosielski, Philipp Bäumer, Heinz-Peter Schlemmer, Antje Wick, Sabine Heiland, Wolfgang Wick and 1 more

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Article in Neuro-oncology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  12. Is Pseudo-progression post-CAR T therapy real?Clinical hematology international · 2026
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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Alexander RadbruchDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Joachim FladtDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Philipp KickingerederDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Benedikt WiestlerDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Martha NowosielskiDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Philipp BäumerDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Heinz-Peter SchlemmerDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Antje WickDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Sabine HeilandDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Wolfgang WickDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).
Martin BendszusDepartment of Neuroradiology, University of Heidelberg, Heidelberg, Germany (A.R., J.F., P.K., P.B., S.H., M.B.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., H.-P.S.); Department of Neurooncology, Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK) Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W., A.W., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAccording to the Response Assessment in Neuro-Oncology criteria, new enhancement within the radiation field on contrast enhanced T1-weighted images within 12 weeks after completion of radiotherapy should not qualify for progressive disease, since up to 50% of these cases may be pseudoprogression (PsP). To validate this concept, we assessed incidence and overall survival (OS) of patients with suspected and confirmed PsP dependent on different time intervals and definitions of PsP.

methodsPatients with newly diagnosed glioblastoma and an enhancement increase of at least 25% after completion of standard radiochemotherapy at month 1, 4, 7, or 10 were eligible. Based on the development of the enhancement in follow-up examinations, patients were categorized as either PsP (subgrouped as complete resolution/decrease >50% and decrease <50%/stable) or true progression.

resultsOut of 548 patients, 79 fulfilled the inclusion criteria. Of these 79 patients, 9 (11.4%) showed PsP (6/45 patients at 1 month, 2/17 at 4 months, 1/9 at 7 months, and 0/8 at 10 months). Complete resolution of the enhancement was found in 1, decrease >50% in 3, decrease <50% in 2, and stable enhancement in 3 patients with PsP. Patients with PsP showed a significantly longer OS (P < .012). No difference in OS was found among PsP subgroups.

conclusionsThis series challenges the current concept of PsP. Even though we could confirm a prolonged OS of patients with PsP, the incidence of PsP was lower than reported previously and extended beyond 12 weeks.

Indexed as

Disease ProgressionAdultBrain NeoplasmsContrast MediaFemaleGlioblastomaHumansIncidenceKaplan-Meier EstimateMagnetic Resonance ImagingRetrospective StudiesContrast Mediaglioblastomapseudoprogression

Identifiers

PMID25038253
PMCPMC4483046

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.