Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3
BackgroundRadiation-induced changes following proton beam therapy in isocitrate dehydrogenase (IDH)-mutated diffuse central nervous system (CNS) World Health Organization (WHO) grade 2 and 3 gliomas are not well characterized. We present a patient with an IDH-mutant astrocytoma CNS WHO grade 3 treat...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1397912/full |
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| author | Liv Cathrine Heggebø Liv Cathrine Heggebø Ida Maria Henriksen Borgen Ida Maria Henriksen Borgen Hanne Blakstad Hanne Blakstad Cathrine Saxhaug Pål André Rønning Pitt Frederik Niehusmann Katja Werlenius Malin Blomstrand Malin Blomstrand Petter Brandal Petter Brandal |
| author_facet | Liv Cathrine Heggebø Liv Cathrine Heggebø Ida Maria Henriksen Borgen Ida Maria Henriksen Borgen Hanne Blakstad Hanne Blakstad Cathrine Saxhaug Pål André Rønning Pitt Frederik Niehusmann Katja Werlenius Malin Blomstrand Malin Blomstrand Petter Brandal Petter Brandal |
| author_sort | Liv Cathrine Heggebø |
| collection | DOAJ |
| description | BackgroundRadiation-induced changes following proton beam therapy in isocitrate dehydrogenase (IDH)-mutated diffuse central nervous system (CNS) World Health Organization (WHO) grade 2 and 3 gliomas are not well characterized. We present a patient with an IDH-mutant astrocytoma CNS WHO grade 3 treated with proton beam therapy and with postradiation MRI changes suggestive of neoplastic progression that surprisingly turned out to be reactive.Case presentationA man in his twenties underwent surgery with a near gross total resection for what turned out to be an IDH-mutant astrocytoma CNS WHO grade 3. He was included in the PRO-GLIO trial and randomized to receive proton beam therapy to a total dose of 59.4 Gray (Gy) relative biological effectiveness (RBE). Four weeks after completion of radiotherapy, adjuvant temozolomide was commenced. All treatment was well tolerated, and the patient was in excellent general condition. Surprisingly, magnetic resonance imaging (MRI) examination three months after completion of radiotherapy showed what was highly suggestive of a distant recurrence. The patient underwent resective surgery about seven months after his first surgery. Histological examination showed inflammatory changes without neoplastic tissue, albeit not very typical for postradiation changes. Adjuvant chemotherapy with temozolomide was continued.ConclusionThe presented case clearly shows that caution must be taken when interpreting cerebral MRI changes postradiation, and in particular after proton therapy. Further understanding of this subject is crucial to distinguish between patients requiring intensified antineoplastic treatment and those for whom maintaining current therapy or ongoing watchful waiting is advisable. |
| format | Article |
| id | doaj-art-2ce5842f62aa43908a1ee24bc7e88da7 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-2ce5842f62aa43908a1ee24bc7e88da72025-01-30T06:22:10ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011510.3389/fonc.2025.13979121397912Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3Liv Cathrine Heggebø0Liv Cathrine Heggebø1Ida Maria Henriksen Borgen2Ida Maria Henriksen Borgen3Hanne Blakstad4Hanne Blakstad5Cathrine Saxhaug6Pål André Rønning7Pitt Frederik Niehusmann8Katja Werlenius9Malin Blomstrand10Malin Blomstrand11Petter Brandal12Petter Brandal13Department of Oncology, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Oncology, Oslo University Hospital, Oslo, NorwayDepartment of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, NorwayDepartment of Oncology, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Radiology, Oslo University Hospital, Oslo, NorwayDepartment of Neurosurgery, Oslo University Hospital, Oslo, NorwayDepartment of Pathology, Oslo University Hospital, Oslo, NorwayDepartment of Oncology, Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Oncology, Sahlgrenska University Hospital, Gothenburg, SwedenThe Skandion Clinic, Uppsala, SwedenDepartment of Oncology, Oslo University Hospital, Oslo, NorwayInstitute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, NorwayBackgroundRadiation-induced changes following proton beam therapy in isocitrate dehydrogenase (IDH)-mutated diffuse central nervous system (CNS) World Health Organization (WHO) grade 2 and 3 gliomas are not well characterized. We present a patient with an IDH-mutant astrocytoma CNS WHO grade 3 treated with proton beam therapy and with postradiation MRI changes suggestive of neoplastic progression that surprisingly turned out to be reactive.Case presentationA man in his twenties underwent surgery with a near gross total resection for what turned out to be an IDH-mutant astrocytoma CNS WHO grade 3. He was included in the PRO-GLIO trial and randomized to receive proton beam therapy to a total dose of 59.4 Gray (Gy) relative biological effectiveness (RBE). Four weeks after completion of radiotherapy, adjuvant temozolomide was commenced. All treatment was well tolerated, and the patient was in excellent general condition. Surprisingly, magnetic resonance imaging (MRI) examination three months after completion of radiotherapy showed what was highly suggestive of a distant recurrence. The patient underwent resective surgery about seven months after his first surgery. Histological examination showed inflammatory changes without neoplastic tissue, albeit not very typical for postradiation changes. Adjuvant chemotherapy with temozolomide was continued.ConclusionThe presented case clearly shows that caution must be taken when interpreting cerebral MRI changes postradiation, and in particular after proton therapy. Further understanding of this subject is crucial to distinguish between patients requiring intensified antineoplastic treatment and those for whom maintaining current therapy or ongoing watchful waiting is advisable.https://www.frontiersin.org/articles/10.3389/fonc.2025.1397912/fullIDH-mutant astrocytomadiffuse gliomapseudoprogressionproton beam therapyradiotherapy |
| spellingShingle | Liv Cathrine Heggebø Liv Cathrine Heggebø Ida Maria Henriksen Borgen Ida Maria Henriksen Borgen Hanne Blakstad Hanne Blakstad Cathrine Saxhaug Pål André Rønning Pitt Frederik Niehusmann Katja Werlenius Malin Blomstrand Malin Blomstrand Petter Brandal Petter Brandal 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 IDH-mutant astrocytoma diffuse glioma pseudoprogression proton beam therapy radiotherapy |
| title | Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3 |
| title_full | Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3 |
| title_fullStr | Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3 |
| title_full_unstemmed | Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3 |
| title_short | Case report: Pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an IDH-mutant astrocytoma CNS WHO grade 3 |
| title_sort | case report pseudoprogression mimicking neoplastic recurrence three months after completion of proton beam therapy for an idh mutant astrocytoma cns who grade 3 |
| topic | IDH-mutant astrocytoma diffuse glioma pseudoprogression proton beam therapy radiotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1397912/full |
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