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First published on March 16, 2009
This version was published on January 1, 2009
Neuro Oncol 2009 11(4):430-436; DOI:10.1215/15228517-2008-107
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Duke University Press

Clinical Investigations

Pseudoprogression in boron neutron capture therapy for malignant gliomas and meningiomas

Shin-Ichi Miyatake, Shinji Kawabata, Naosuke Nonoguchi, Kunio Yokoyama, Toshihiko Kuroiwa, Hideki Matsui and Koji Ono

Department of Neurosurgery, Osaka Medical College, Osaka (S.-I.M., S.K., N.N., K.Y., T.K.); Department of Physiology, Okayama University, Graduate School of Medicine and Dentistry, Okayama (H.M.); Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, Kyoto (K.O.); Japan

Address correspondence to Shin-Ichi Miyatake, Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan (neu070{at}poh.osaka-med.ac.jp).

Pseudoprogression has been recognized and widely accepted in the treatment of malignant gliomas, as transient increases in the volume of the enhanced area just after chemoradiotherapy, especially using temozolomide. We experienced a similar phenomenon in the treatment of malignant gliomas and meningiomas using boron neutron capture therapy (BNCT), a cell-selective form of particle radiation. Here, we introduce representative cases and analyze the pathogenesis. Fifty-two cases of malignant glioma and 13 cases of malignant meningioma who were treated by BNCT were reviewed retrospectively mainly via MR images. Eleven of 52 malignant gliomas and 3 of 13 malignant meningiomas showed transient increases of enhanced volume in MR images within 3 months after BNCT. Among these cases, five patients with glioma underwent surgery because of suspicion of relapse. In histology, most of the specimens showed necrosis with small amounts of residual tumor cells. Ki-67 labeling showed decreased positivity compared with previous samples from the individuals. Fluoride-labeled boronophenylalanine PET was applied in four and two cases of malignant gliomas and meningiomas, respectively, at the time of transient increase of lesions. These PET scans showed decreased lesion:normal brain ratios in all cases compared with scans obtained prior to BNCT. With or without surgery, all lesions were decreased or stable in size during observation. Transient increases in enhanced volume in malignant gliomas and meningiomas immediately after BNCT seemed to be pseudoprogression. This pathogenesis was considered as treatment-related intratumoral necrosis in the subacute phase after BNCT.

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


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