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Meningioma — SCE Medical Oncology MCQ

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HardCNS TumoursMeningiomaSCE Medical Oncology

Eight weeks after completing radiotherapy with temozolomide for an MGMT-methylated glioblastoma, a clinically stable patient has increased enhancement confined to the high-dose field. Diffusion is not restricted and perfusion is low. What is the most appropriate interpretation and next step?

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Correct answer: E — Favour treatment-related pseudoprogression and repeat MRI at a short interval

Early in-field enhancement after chemoradiotherapy with low perfusion, no restriction and clinical stability favours pseudoprogression and short-interval MRI review. Favour early true progression and repeat MRI at a short interval: the timing, field confinement, low perfusion and clinical stability favour treatment effect. Favour mature radiation necrosis and repeat MRI at a short interval: mature necrosis more commonly arises later, although treatment-effect biology overlaps. Favour temozolomide-related infection and repeat MRI at a short interval: infection lacks supporting systemic, diffusion or anatomical findings. Favour ischaemic infarction and repeat MRI at a short interval: the enhancement pattern and absence of restricted diffusion are not typical of infarction.

Reference: RANO 2.0 response-assessment criteria for adult gliomas (Published October 2023): https://pubmed.ncbi.nlm.nih.gov/37774317/; NICE NG99 brain tumours and metastases: recommendations (Updated January 2021; current surveillance): https://www.nice.org.uk/guidance/ng99/chapter/recommendations