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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleHead and Neck Imaging

Imaging Manifestations of Pseudoprogression in Metastatic Melanoma Nodes Injected with Talimogene Laherparepvec: Initial Experience

C. Zamora, M. Lopez, F. Cunningham, F. Collichio and M. Castillo
American Journal of Neuroradiology June 2017, 38 (6) 1218-1222; DOI: https://doi.org/10.3174/ajnr.A5206
C. Zamora
aFrom the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
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M. Lopez
aFrom the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
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F. Cunningham
bthe Division of Hematology and Oncology, Department of Medicine (F. Cunningham, F. Collichio), University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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F. Collichio
bthe Division of Hematology and Oncology, Department of Medicine (F. Cunningham, F. Collichio), University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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M. Castillo
aFrom the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
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    Fig 1.

    Line graph showing change in size over time relative to baseline CT. A, Fifty percent of nodes showed initial growth followed by decreased size. One node (marked with an asterisk at last time point) demonstrated a continued increase in size, but could not be followed after 184 days. B, Forty-two percent of nodes showed a downward trend in size. The final size was smaller than baseline in all nodes except for the one indicated in A.

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    Fig 2.

    A, Coronal contrast-enhanced CT shows a round, well-circumscribed necrotic lesion (black arrow) at the inferior aspect of the right parotid gland. B, The lesion has increased in size and developed infiltrative margins (white arrow) 72 days after injection. Follow-up at 111 days (C) and 184 days (D) after injection demonstrates further growth and marked increase in central necrosis. E, The lesion shows decreased size after 337 days.

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    Fig 3.

    A, Axial contrast-enhanced CT shows a small nodule in the deep right breast/axillary region (white arrow). The lesion shows slight central hypoattenuation and increased size at 34 days after injection (white arrow, B) with the development of frank central necrosis after 72 days (black arrow, C). There is a mild further increase in size at 104 days (D), followed by decreased size at 125 days (E) and near complete resolution at 174 days (F).

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  • Clinical features, disease stage, final nodal size (relative to baseline CT), and patient outcome

    Patient No.Lesion No.Age, yrSexStageBRAF StatusLocationFinal Lesion SizePatient Outcome
    1163FT3bN3M1aNegativeLeft supraclavicularDecreasedRemission.
    2266MTxNxM1cWild typeRight supraclavicularDecreasedT-VEC discontinued after disease progression in ribs. Placed on nivolumab with partial response.
    3Right supraclavicularDecreased
    3440MpT1bN3M1cPositiveRight preauricularDecreasedIL-2 followed by BRAF and MEK inhibitors after ipilimumab/T-VEC treatment. Deceased.
    5Right submandibularDecreased
    4644MT3bN3M1bPositiveRight axillaryDecreasedBRAF and MEK inhibitors after ipilimumab/T-VEC treatment, followed by disease progression. Deceased.
    7Right axillaryDecreased
    5858FT3bN2M1aWild typeLeft upper backDecreasedComplete response for 21 months, followed by axillary recurrence. Placed on nivolumab.
    9Left breastDecreased
    61032MT4bN3M1aNegativeLeft retroauricularDecreasedPartial response for 6 months. Placed on nivolumab.
    71163MT3aN3M1cNegativeRight chest wallIncreasedRapid deterioration after brain metastases. Deceased.
    12Right axillaDecreased
    • Note:—IL-2 indicates interleukin 2.

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American Journal of Neuroradiology: 38 (6)
American Journal of Neuroradiology
Vol. 38, Issue 6
1 Jun 2017
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Cite this article
C. Zamora, M. Lopez, F. Cunningham, F. Collichio, M. Castillo
Imaging Manifestations of Pseudoprogression in Metastatic Melanoma Nodes Injected with Talimogene Laherparepvec: Initial Experience
American Journal of Neuroradiology Jun 2017, 38 (6) 1218-1222; DOI: 10.3174/ajnr.A5206

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Imaging Manifestations of Pseudoprogression in Metastatic Melanoma Nodes Injected with Talimogene Laherparepvec: Initial Experience
C. Zamora, M. Lopez, F. Cunningham, F. Collichio, M. Castillo
American Journal of Neuroradiology Jun 2017, 38 (6) 1218-1222; DOI: 10.3174/ajnr.A5206
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