ArticleJournal of neuro-oncology2021
Distinct imaging patterns of pseudoprogression in glioma patients following proton versus photon radiation therapy.
Article in Journal of neuro-oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Evidence-based indications for proton therapy in adults determined using the GRADE approach.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Pooled it
- Article
- Isocitrate Dehydrogenase-Mutant Astrocytomas: Risk Stratification and Therapeutic Advance.MedComm · 2026Review
- Relative Biological Effectiveness-Clinical Practice at US Proton Therapy Centers.International journal of particle therapy · 2025Article
- Proton therapy for adult type IDH-mutated glioma: Proglio-1, a multicenter retrospective study.Radiation oncology (London, England) · 2025Article
- A volumetric analysis of timing and duration of T2/FLAIR changes on MRI following radiation therapy in patients with low-grade IDH-mutant glioma.Neuro-oncology practice · 2025Article
- A scoping review of proton radiation therapy and mutant-isocitrate dehydrogenase-inhibitors in IDH mutated lower-grade gliomas: pushing beyond surrogate end-points.Acta neurochirurgica · 2025Article
- Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3.Frontiers in oncology · 2025Article
- Progression-free survival versus post-progression survival and overall survival in WHO grade 2 gliomas.Acta oncologica (Stockholm, Sweden) · 2024Observational
- Critical Appraisal of Proton Therapy for Patients with Central Nervous System (CNS) Malignancies.Current treatment options in oncology · 2023Review
- Investigating survival, quality of life and cognition in PROton versus photon therapy forBMJ open · 2023Article
- Mechanisms and Review of Clinical Evidence of Variations in Relative Biological Effectiveness in Proton Therapy.International journal of radiation oncology, biology, physics · 2022Review
- Imaging patterns of glioblastoma progression: Comparative analysis of sequential proton boost versus conventional photon therapy.Neuro-oncology advancesArticle
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeCriteria by the Radiologic Assessment in Neuro-Oncology (RANO) group outline the diagnosis of pseudoprogression (Ps) after photon therapy for gliomas based on timing and location. We noted that patients receiving proton therapy manifested radiographic changes that appear different than Ps after photon therapy, which could be interpreted as tumor progression. In this study, we retrospectively reviewed MR imaging after proton or photon radiation for gliomas. We propose criteria to characterize proton pseudoprogression (ProPs) as distinct from Ps seen after photons.
methodsPost-treatment MR imaging, clinical and pathological data of low grade glioma patients were reviewed. Overall, 57 patients receiving protons were reviewed for the presence of ProPs, and 43 patients receiving photons were reviewed for any equivalent imaging changes. Data collected included the location and timing of the new enhancement, tumor grade, molecular subtype, chemotherapy received, and clinical symptoms.
resultsFourteen patients (24.6%) had new enhancement following radiation therapy that was unique to treatment with protons. The mean time to development of the ProPs was 15.4 months (7-27 months). We established the following criteria to characterize ProPs: located at the distal end of the proton beam; resolves without tumor-directed therapy; and subjectively multifocal, patchy, and small (< 1 cm). In the group receiving photons, none had changes that met our criteria for ProPs.
conclusionPatients who receive protons have unique imaging changes after radiation therapy. ProPs could be mistaken for tumor progression, but typically resolves on follow up. Further studies are needed to understand the radiobiology and pathophysiology underlying these imaging changes.
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