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@ARTICLE{Zeyen:282920,
      author       = {T. Zeyen and D. Paech and J. Weller and N. Schäfer and T.
                      Tzaridis and C. Duffy and L. Nitsch and M. Schneider and
                      A.-L. Potthoff and J. P. Steinbach and P. Hau and U.
                      Schlegel and C. Seidel and D. Krex and O. Grauer and R.
                      Goldbrunner and P. S. Zeiner and G. Tabatabai and N.
                      Galldiks and W. Stummer and E. Hattingen and M. Glas$^*$ and
                      A. Radbruch and U. Herrlinger and C. Schaub},
      title        = {{U}ndetected pseudoprogressions in the {C}e{T}e{G}/{NOA}-09
                      trial: hints from postprogression survival and {MRI}
                      analyses.},
      journal      = {Journal of neuro-oncology},
      volume       = {164},
      number       = {3},
      issn         = {0167-594x},
      address      = {Dordrecht [u.a.]},
      publisher    = {Springer Science + Business Media B.V},
      reportid     = {DKFZ-2023-01909},
      pages        = {607-616},
      year         = {2023},
      note         = {2023 Sep;164(3):607-616},
      abstract     = {In the randomized CeTeG/NOA-09 trial,
                      lomustine/temozolomide (CCNU/TMZ) was superior to TMZ
                      therapy regarding overall survival (OS) in MGMT
                      promotor-methylated glioblastoma. Progression-free survival
                      (PFS) and pseudoprogression rates (about $10\%)$ were
                      similar in both arms. Further evaluating this discrepancy,
                      we analyzed patterns of postprogression survival (PPS) and
                      MRI features at first progression according to modified RANO
                      criteria (mRANO).We classified the patients of the
                      CeTeG/NOA-09 trial according to long vs. short PPS employing
                      a cut-off of 18 months and compared baseline characteristics
                      and survival times. In patients with available MRIs and
                      confirmed progression, the increase in T1-enhancing, FLAIR
                      hyperintense lesion volume and the change in ADC mean value
                      of contrast-enhancing tumor upon progression were
                      determined.Patients with long PPS in the CCNU/TMZ arm had a
                      particularly short PFS (5.6 months). PFS in this subgroup
                      was shorter than in the long PPS subgroup of the TMZ arm
                      (11.1 months, p = 0.01). At mRANO-defined progression,
                      patients of the CCNU/TMZ long PPS subgroup had a
                      significantly higher increase of mean ADC values (p = 0.015)
                      and a tendency to a stronger volumetric increase in
                      T1-enhancement (p = 0.22) as compared to long PPS patients
                      of the TMZ arm.The combination of survival and MRI analyses
                      identified a subgroup of CCNU/TMZ-treated patients with
                      features that sets them apart from other patients in the
                      trial: short first PFS despite long PPS and significant
                      increase in mean ADC values upon mRANO-defined progression.
                      The observed pattern is compatible with the features
                      commonly observed in pseudoprogression suggesting
                      mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of
                      CeTeG/NOA-09.},
      keywords     = {Glioblastoma (Other) / MGMT promotor methylation (Other) /
                      MRI (Other) / Progression (Other) / Pseudoprogression
                      (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37728779},
      doi          = {10.1007/s11060-023-04444-x},
      url          = {https://inrepo02.dkfz.de/record/282920},
}