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First published on March 16, 2009
A more recent version of this article appeared on January 1, 2009
Neuro Oncol 2009, DOI:10.1215/15228517-2008-107
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© Copyright 2009 by the Society for Neuro-Oncology

Received July 13, 2008
Accepted November 4, 2008

Clinical Investigations

Pseudoprogression in boron neutron capture therapy for malignant gliomas and meningiomas

Shin-Ichi Miyatake 1*, Shinji Kawabata 2, Naosuke Nonoguchi 2, Kunio Yokoyama 2, Toshihiko Kuroiwa 2, Koji Ono 3

1 Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
2 Department of Neurosurgery, Osaka Medical College, Osaka, Japan
3 Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, Kyoto, Japan

* To whom correspondence should be addressed. E-mail: neu070{at}poh.osaka-med.ac.jp.


  Abstract

Pseudoprogression has been recognized and widely accepted in the treatments for malignant gliomas, as transient increase in volume of enhanced area just after the chemo-radiotherapy, especially using temozolomide. We experienced the similar phenomenon in the treatments of malignant gliomas and meningiomas using cell-selective particle radiation, boron neutron capture therapy (BNCT). Here we introduce the representative cases and analyze this pathogenesis. Fifty two cases of malignant glioma and 13 cases of malignant meningioma who were treated by BNCT were reviewed retrospectively mainly in MRI. Eleven out of 52 malignant gliomas and 3 out of 13 malignant meningiomas showed transient increase of enhanced volume in MRI within 3 months after BNCT. In these cases, 5 glioma cases underwent operation for the suspicion of relapse. In histology, most part of the specimen showed necrosis with small amount of tumor cell residual. Ki-67 labeling index showed decreased positivity in comparison with previous samples of the individuals. Fluororide-labeled boronophenylalanine positron emission tomography (PET) was applied in 4 and 2 cases of malignant gliomas and meningiomas, respectively at the time of transient increase of lesions. These PETs showed decreased lesion/normal brain ratio in all cases in comparison with those obtained prior to BNCT. With surgery or without surgery, all lesions were decreased or stable in size during observation. Transient increase in enhanced volume in malignant gliomas and meningiomas immediately after BNCT seemed to be pesudoprogression. This pathogenesis was considered as treatment-related intra-tumoral necrosis in subacute phase after BNCT.

Key Words: boron neutron capture therapy (BNCT), glioma, malignant meningoma, positron emission tomography (PET), pseudoprogression


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Copyright 2009 by Society for Neuro-Oncology