Nonmeasurable Speckled Contrast-Enhancing Lesions Appearing During Course of Disease Are Associated With IDH Mutation in High-Grade Astrocytoma Patients
Published in
International Journal of Radiation Oncology, Biology, Physics, July 2018
As treatment options at progression are limited for glioma patients, the accuracy in definition of progression is pivotal. Clinically asymptomatic, newly detected, non-measurable, speckled contrast-enhancing lesions (SCE) without immediate relation to prior immune- or radiotherapy appear relatively frequently during course of disease in glioma patients and challenge the definition of progression based on Response Assessment in Neurooncology (RANO) criteria. Therefore, data characterizing these SCEs are needed for recommendations of subsequent clinical management.
MRIs of seven hundred forty-six glioma patients included in this study were retrospectively revised for appearance of newly detected SCEs during course of disease. Associations with molecular and clinical baseline parameters as well as their prognostic impact were statistically analyzed and frequency, natural course and location of SCEs described.
SCEs occurred more frequently in World Health Organization (WHO) grade II and III astrocytoma and oligodendroglial tumors and were significantly associated with isocitrate dehydrogenase (IDH) mutation in WHO grade III astrocytoma and glioblastoma. SCEs mostly remained stable or dissolved in follow-up MRIs, even if no new treatment was initiated. SCEs were frequently located within the tumor or tumor-associated FLAIR abnormalities, but distant appearance also occurred. In glioblastoma patients, SCEs were associated with a favorable prognosis, which was also observed in the subgroup of glioblastoma patients with IDH wildtype status.
The data demonstrate a predominantly benign course of SCEs after its appearance and emphasize for cautious definitions of progression as well as for regular clinical and radiographic follow-ups rather than premature initiation of new anti-tumor therapies until progression is confirmed.
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