DCE-MRI perfusion predicts pseudoprogression in metastatic melanoma treated with immunotherapy Journal Article
| Authors: | Umemura, Y.; Wang, D.; Peck, K. K.; Flynn, J.; Zhang, Z.; Fatovic, R.; Anderson, E. S.; Beal, K.; Shoushtari, A. N.; Kaley, T.; Young, R. J. |
| Article Title: | DCE-MRI perfusion predicts pseudoprogression in metastatic melanoma treated with immunotherapy |
| Abstract: | Purpose: It can be challenging to differentiate pseudoprogression from progression. We assessed the ability of dynamic contrast enhanced T1 MRI (DCE-MRI) perfusion to identify pseudoprogression in melanoma brain metastases. Methods: Patients with melanoma brain metastases who underwent immunotherapy and DCE-MRI were identified. Enhancing lesions ≥ 5mm in diameter on DCE-MRI and that were new or increased in size between a week from beginning the treatment, and a month after completing the treatment were included in the analysis. The 90th percentiles of rVp and rKtrans and the presence or absence of hemorrhage were recorded. Histopathology served as the reference standard for pseudoprogression. If not available, pseudoprogression was defined as neurological and radiographic stability or improvement without any new treatment for ≥ 2 months. Results: Forty-four patients were identified; 64% received ipilimumab monotherapy for a median duration of 9 weeks (range, 1–138). Sixty-four lesions in 44 patients were included in the study. Of these, nine lesions in eight patients were determined to be pseudoprogression and seven lesions were previously irradiated. Forty-four progression lesions and eight pseudoprogression lesions were hemorrhagic. Median lesion volume for pseudoprogression and progression were not significantly different, at 2.3 cm3 and 3.2 cm3, respectively (p = 0.82). The rVp90 was smaller in pseudoprogression versus progression, at 2.2 and 5.3, respectively (p = 0.02), and remained significant after false discovery rate adjustment (p = 0.04). Conclusions: Pseudoprogression exhibited significantly lower rVp90 on DCE-MRI compared with progression. This knowledge can be useful for managing growing lesions in patients with melanoma brain metastases who are receiving immunotherapy. © 2019, Springer Science+Business Media, LLC, part of Springer Nature. |
| Keywords: | adult; clinical article; controlled study; human tissue; aged; histopathology; cancer growth; monotherapy; cancer patient; cancer radiotherapy; ipilimumab; cancer immunotherapy; melanoma; retrospective study; prediction; disease severity; contrast enhancement; brain metastasis; diagnostic error; neurologic disease; brain hemorrhage; perfusion weighted imaging; dce-mri; brain metastases; pseudoprogression; metastatic melanoma; brain damage; immune checkpoint inhibitor; flanvotumab; nivolumab; pidilizumab; human; male; female; article; pembrolizumab; gadobutrol; lirilumab; dynamic contrast enhance t1 magnetic resonance imaging |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 146 |
| Issue: | 2 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2020-01-01 |
| Start Page: | 339 |
| End Page: | 346 |
| Language: | English |
| DOI: | 10.1007/s11060-019-03379-6 |
| PUBMED: | 31873875 |
| PROVIDER: | scopus |
| PMCID: | PMC7545497 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 March 2020 -- Source: Scopus |
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