In ref. 1, the following text was included on page 31:
Because of new progression in 2008, she received PVC (procarbazine, CCNU, vinkristine) (Fig. 1C), and later cyclic TMZ, when MRI showed diffuse changes in the brainstem Cyclic TMZ was administered until June 2009.
The correct wording for this text is as follows:
Because of new progression in 2008, she received PVC (procarbazine, CCNU, vincristine) (Fig. 1C). Later, when MRI showed diffuse changes in her brainstem, cyclic TMZ was administered until June 2009.
Also, a table should have been cited on page 36 in the ‘Clinical recommendations section’, in the following position:
Most patients with pseudoprogression have modest or no new symptoms that correlate with the MRI changes, and the need of steroids is often stable or decreasing. Continuation of planned treatment and new imaging in 2–3 months is recommended, or sooner, if the patient deteriorates. MRI series should include axial, coronal and sagittal T1-weighted imaging, axial T2, and coronal FLAIR. Surgical exploration in a patient with suspected pseudoprogression should be avoided unless immediate diagnostic certainty is adamant. PIPG is a differential diagnosis in patients with repeated or severe epileptic seizures (Table 1).
The missing table 1 is shown below:
|Pseudoprogression||Tumor recurrence||Radiation necrosis||Peri-ictal pseudoprogression|
|Temporal occurrence||Within 3 (–6) months after therapy (radiotherapy, combined therapy)||At any time||3–12 months after therapy, but sometimes after several years||Related to clinical seizure activity|
|Clinical correlates|| |
2/3 no new symptoms, steroid need often stable
1/3 increased symptoms
|Gradual clinical worsening and steroid need||Clinical worsening|| |
Frequent and/or severe seizures
More frequent in irradiated patients
|MRI findings||Increased contrast enhancement and/or edema in the tumor area, resolves with time||Increased contrast enhancement and increased edema in or outside the irradiated areas||Increased enhancement in irradiated area only, stabilizes with time||Focal cortical and/or leptomeningeal enhancing lesions, resolves with seizure control|
|Histologic verification (biopsy)||Usually not required, but sometimes of relevance||Required in some cases||Rarely required, unless diagnostic uncertainty||Should be avoided|
|Recommendations||Continue treatment, repeat MRI, consider increase in steroid doses if symptomatic||Discontinue current therapy, consider other options; palliative care||Increase steroid doses, repeat MRI||Optimalize antiepileptic treatment, repeat MRI|
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