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Glioblastoma progression on or after first-line Stupp regimen: MRI evidence of true progr...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-GBM-TRANSFORMATION-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-27 | pending_clinical_signoff
DiseasesDIS-GBM
SourcesSRC-EANO-GBM-2024 SRC-NCCN-CNS-2025

Red Flag Origin

DefinitionGlioblastoma progression on or after first-line Stupp regimen: MRI evidence of true progression (RANO criteria — distinguished from pseudoprogression by serial imaging / advanced techniques), early recurrence <6 months post-RT (often pseudoprogression — repeat MRI at 4-8 weeks before re-treatment decision), or distant new lesion. Routes from upfront Stupp to recurrent-GBM algorithm (re-resection + bevacizumab / TTF / regorafenib / lomustine / re-irradiation).
Clinical directionintensify
Categorytransformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "gbm_rano_progression",
      "value": true
    },
    {
      "finding": "gbm_distant_new_lesion",
      "value": true
    },
    {
      "finding": "gbm_early_recurrence_lt_6mo_post_rt",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Pseudoprogression occurs in ~30% post-Stupp at 3 mo MRI — does not represent true tumor growth (treatment-related inflammation / radiation effect); RANO criteria require either second confirmatory MRI or outside-RT-field new disease before declaring progression. Confirmed recurrence: re-resection if accessible (gross-total benefit per retrospective series); systemic options include bevacizumab (BELOB, AVAglio — improves PFS, no OS benefit; useful for steroid-sparing edema control), regorafenib (REGOMA), lomustine, TMZ rechallenge if MGMT-methylated and >12 mo PFS to first TMZ. Tumor-treating fields approved for recurrence per EF-11. shifts_algorithm empty pending ALGO-GBM-RECURRENT-2L authoring.

Used By

Indications