[Radiation therapy for glial tumors: technical aspects and clinical indications]

Noninvasive evaluation of radiation-enhanced glioma cells invasiveness by ultra-high-field (1)H-MRS in vitro

INTRODUCTION

Glioma is the most common type of the primary CNS tumor. Radiotherapy is an important treatment measure after surgery. However, its highly invasive character is the main reason of postoperative recurrence. The aim of the study was to probe the correlation between the invasion ability and the metabolite characteristics of glioma cells at the cellular level after irradiation by using 14.7T high-resolution nuclear proton magnetic resonance spectroscopy ((1)H-MRS).

METHODS

To determine the matrix metalloproteinase-2 (MMP-2) activity and metabolite ratios of glioma cells after irradiation with different doses of X-rays, U87 and C6 glioma cells were exposed to X-ray irradiation of 0, 1, 5, 10, and 15Gy. After 20h, the perchloric acid (PCA) extraction method was used to evaluate water-soluble metabolites [choline (Cho), creatine (Cr), and N-acetylaspartate (NAA)], and (1)H-MRS patterns and changes in metabolite ratios were observed in vitro by 14.7T high resolution (1)H-MRS. Matrigel invasion assays and gelatin zymography were performed to test the invasion ability of U87 and C6 glioma cells.

RESULTS

Good MR spectra were obtained from PCA method extracts of U87 and C6 glioma cells. Both radiation-induced MMP-2 activity and the Cho/Cr and Cho/NAA ratios increased after irradiation, and their increase occurred in a dose-dependent manner. The MMP-2 activity and the Cho/Cr and Cho/NAA ratios of glioma cells increased after irradiation up to 10Gy and decreased thereafter. In particular, the Cho/NAA ratio of U87 cells increased from 3.55±0.06 (0Gy) to 9.13±0.30 (10Gy) and then declined to 5.94±0.15 (15Gy). Furthermore, the invasion ability of glioma cells had a strong positive correlation with the Cho/Cr and Cho/NAA ratios. Both the Cho/Cr ratio and the Cho/NAA ratio of U87 glioma cells were highly positively correlated with the number of invading cells in the Matrigel invasion assay. The Pearson's correlation coefficient (r) values of U87 cells were 0.89 (Cho/Cr ratio versus invasion ability) and 0.91 (Cho/NAA ratio versus invasion ability) (P<0.01). C6 cells exhibited similar changes to those of U87 cells.

CONCLUSIONS

In vitro high-resolution (1)H-MRS is useful for detecting glioma invasiveness at the cellular level.

Assessment of the intrinsic radiosensitivity of glioma cells and monitoring of metabolite ratio changes after irradiation by 14.7-T high-resolution ¹H MRS

Gliomas are the most common type of primary brain tumor. Radiation therapy (RT) is the primary adjuvant treatment to eliminate residual tumor tissue after surgery. However, the current RT guided by conventional imaging is unsatisfactory. A fundamental question is whether it is possible to further enhance the effectiveness and efficiency of RT based on individual radiosensitivity. In this research, to probe the correlation between radiosensitivity and the metabolite characteristics of glioma cells in vitro, a perchloric acid (PCA) extracting method was used to obtain water-soluble metabolites [such as N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and succinate (Suc)]. Spectral patterns from these processed water-soluble metabolite samples were acquired by in vitro 14.7-T high-resolution ¹H MRS. Survival fraction analysis was performed to test the intrinsic radiosensitivity of glioma cell lines. Good ¹H MRS of PCA extracts from glioma cells was obtained. The radiosensitivity of glioma cells correlated positively with the Cho/Cr and Cho/NAA ratios, but negatively with the Suc/Cr ratio. Irradiation of the C6 cell line at different X-ray dosages led to changes in metabolite ratios and apoptotic rates. A plateau phase of metabolite ratio change and a decrease in apoptotic rate were found in the C6 cell line. We conclude that in vitro high-resolution ¹H MRS possesses the sensitivity required to detect subtle biochemical changes at the cellular level. ¹H MRS may aid in the assessment of the individual radiosensitivity of brain tumors, which is pivotal in the identification of the biological target volume.

Whole brain radiation-induced cognitive impairment: pathophysiological mechanisms and therapeutic targets

Radiation therapy, the most commonly used for the treatment of brain tumors, has been shown to be of major significance in tu-mor control and survival rate of brain tumor patients. About 200,000 patients with brain tumor are treated with either partial large field or whole brain radiation every year in the United States. The use of radiation therapy for treatment of brain tumors, however, may lead to devastating functional deficits in brain several months to years after treatment. In particular, whole brain radiation therapy results in a significant reduction in learning and memory in brain tumor patients as long-term consequences of treatment. Although a number of in vitro and in vivo studies have demonstrated the pathogenesis of radiation-mediated brain injury, the cel-lular and molecular mechanisms by which radiation induces damage to normal tissue in brain remain largely unknown. Therefore, this review focuses on the pathophysiological mechanisms of whole brain radiation-induced cognitive impairment and the iden-tification of novel therapeutic targets. Specifically, we review the current knowledge about the effects of whole brain radiation on pro-oxidative and pro-inflammatory pathways, matrix metalloproteinases (MMPs)/tissue inhibitors of metalloproteinases (TIMPs) system and extracellular matrix (ECM), and physiological angiogenesis in brain. These studies may provide a foundation for defin-ing a new cellular and molecular basis related to the etiology of cognitive impairment that occurs among patients in response to whole brain radiation therapy. It may also lead to new opportunities for therapeutic interventions for brain tumor patients who are undergoing whole brain radiation therapy.

Basic fibroblast growth factor protects C17.2 cells from radiation-induced injury through ERK1/2

AIMS

To establish a radiation-induced neural injury model using C17.2 neural stem cells (NSCs) and to investigate whether basic fibroblast growth factor (bFGF) can protect the radiation-induced injury of C17.2 NSCs. Furthermore, we aim to identify the possible mechanisms involved in this model.

METHODS

C17.2 NSCs received a single exposure (3, 6, and 9 Gy, respectively) at a dose rate of 300 cGy/min with a control group receiving 0 Gy. Different concentrations of bFGF were added for 24 h, 5 min postirradiation. The MTS assay and flow cytometry were used to detect cytotoxicity and apoptosis. Expression of FGFR1, ERK1/2, and p-ERK1/2 proteins was detected with or without U0126 was pretreated prior to C17.2 NSCs receiving irradiation.

RESULTS

C17.2 NSCs showed a dose-dependent cell death as the dose of radiation was increased. Additionally, the rate of apoptosis in the C17.2 NSCs reached 31.2 ± 1.23% in the 6 Gy irradiation group, which was the most significant when compared to the other irradiation treated groups. bFGF showed protective effect on cell apoptosis in a dose-dependent manner. The mean percentage of apoptotic cells decreased to 7.83 ± 1.75% when 100 ng/mL bFGF was given. Furthermore, U0126 could block the protective effect of bFGF by inhibiting the phosphorylation of ERK1/2.

CONCLUSIONS

An in vitro cellular model of radiation-induced apoptosis of NSCs, in C17.2 NSCs, was developed successfully. Additionally, bFGF can protect neurons from radiation injury in vitro via the ERK1/2 signal transduction pathway.

Irradiation alters MMP-2/TIMP-2 system and collagen type IV degradation in brain

PURPOSE

Blood-brain barrier (BBB) disruption is one of the major consequences of radiation-induced normal tissue injury in the central nervous system. We examined the effects of whole-brain irradiation on matrix metalloproteinases (MMPs)/tissue inhibitors of metalloproteinases (TIMPs) and extracellular matrix (ECM) degradation in the brain.

METHODS AND MATERIALS

Animals received either whole-brain irradiation (a single dose of 10 Gy γ-rays or a fractionated dose of 40 Gy γ-rays, total) or sham-irradiation and were maintained for 4, 8, and 24 h following irradiation. mRNA expression levels of MMPs and TIMPs in the brain were analyzed by real-time reverse transcriptase-polymerase chain reaction (PCR). The functional activity of MMPs was measured by in situ zymography, and degradation of ECM was visualized by collagen type IV immunofluorescent staining.

RESULTS

A significant increase in mRNA expression levels of MMP-2, MMP-9, and TIMP-1 was observed in irradiated brains compared to that in sham-irradiated controls. In situ zymography revealed a strong gelatinolytic activity in the brain 24 h postirradiation, and the enhanced gelatinolytic activity mediated by irradiation was significantly attenuated in the presence of anti-MMP-2 antibody. A significant reduction in collagen type IV immunoreactivity was also detected in the brain at 24 h after irradiation. In contrast, the levels of collagen type IV were not significantly changed at 4 and 8 h after irradiation compared with the sham-irradiated controls.

CONCLUSIONS

The present study demonstrates for the first time that radiation induces an imbalance between MMP-2 and TIMP-2 levels and suggests that degradation of collagen type IV, a major ECM component of BBB basement membrane, may have a role in the pathogenesis of brain injury.

Fractionated radiation-induced acute encephalopathy in a young rat model: cognitive dysfunction and histologic findings

BACKGROUND AND PURPOSE

Radiation-induced cognitive dysfunction is a common and serious complication after radiation therapy of brain tumor, yet knowledge of its mechanism is poorly understood. The aim of this study was to establish a young rat model for acute radiation encephalopathy, at both cognitive and pathologic levels, induced by fractionated irradiation.

MATERIALS AND METHODS

Four-week-old male rats were randomized into sham (0 Gy) and 2 experimental groups receiving fractionated irradiation of 5 Gy/day, 5 days/week, with total doses of 20 and 40 Gy, respectively. Cognition, BBB integrity, and potential astrogliosis were evaluated at 0, 4, 8, and 12 weeks' postirradiation.

RESULTS

Twenty-Gy irradiation led to transient cognitive impairment only at 4 weeks' postirradiation. Forty-Gy irradiation induced cognitive impairment at both 4 and 8 weeks' postirradiation, which was more severe than that induced by 20 Gy. Cognitive impairment was accompanied by a transient increase in BWC only at 4 weeks for the 40-Gy group. Disrupted BBB permeability was detected at 4 and 8 weeks' postirradiation for the 20-Gy group, and at 4, 8, and 12 weeks' postirradiation for 40-Gy group, respectively. Increased astrogliosis in the hippocampus could be detected at 4 weeks' postirradiation for 40-Gy group.

CONCLUSIONS

Fractionated irradiation in this experiment could induce acute brain injury, leading to cognitive impairment in young rats. BBB disruption might be a sensitive index for acute radiation encephalopathy. In addition, reactive astrogliosis might play an important role in this process. The present model, especially the 40-Gy irradiation group, is useful for basic and therapeutic studies of acute radiation encephalopathy.

[Malignant gliomas]

Glial tumors represent 2000 to 3000 new cases per year in France and 75% of them are of high grade. Recent understanding of the molecular biology of these tumors revealed the importance of 1p19q codeletion and mgMT promotor methylation. Radiotherapy also recently evolved with the progress in medical imaging which allows a better definition of the target volumes. Even modest, therapeutic progress is based on chemoradiotherapy with temozolomide and on the development of non-coplanar conformational radiotherapy. Knowledge and precise evaluation of potential late effects of our treatments is necessary due to actual improvement of survival with chemoradiotherapy in glioblastoma.

External irradiation models for intracranial 9L glioma studies

PURPOSE

Radiotherapy has been shown to be an effective for the treatment human glioma and consists of 30 fractions of 2 Gy each for 6-7 weeks in the tumor volume with margins. However. in preclinical studies, many different radiation schedules are used. The main purpose of this work was to review the relevant literature and to propose an external whole-brain irradiation (WBI) protocol for a rat 9L glioma model.

MATERIALS AND METHODS

9L cells were implanted in the striatum of twenty 344-Fisher rats to induce a brain tumor. On day 8, animals were randomized in two groups: an untreated group and an irradiated group with three fractions of 6 Gy at day 8, 11 and 14. Survival and toxicity were assessed.

RESULTS

Irradiated rats had significantly a longer survival (p = 0.01). No deaths occurred due to the treatment. Toxicities of reduced weight and alopecia were increased during the radiation period but no serious morbidity or mortality was observed. Moreover, abnormalities disappeared the week following the end of the therapeutic schedule.

CONCLUSIONS

Delivering 18 Gy in 3 fractions of 6 Gy every 3 days, with mild anaesthesia, is safe, easy to reproduce and allows for standardisation in preclinical studies of different treatment regimens glioma rat model.

[Radiotherapy in adult glioblastomas]

Radiation therapy is a treatment of malignant gliomas in adults. It improves survival rates, whether used alone, in addition to surgery, or in combination with chemotherapy. Three-dimensional imaging techniques, image fusion, and conformational radiotherapy are optimizing treatment plans for the treatment of these tumors and are sparing healthy tissue. After a review of the physical and biological bases of ionizing radiation, we present the techniques, results, side effects, and results of irradiation of glioblastomas.

[Role of perfusion, vascular permeability and anatomic MR imaging in radiation therapy for gliomas]

There is no clear consensus for tumour volume definition in radiotherapy of brain tumours, particularly for high-grade gliomas (HGG). They are infiltrative and heterogeneous, sub-populations of low and high grade can coexist inside one tumour volume, and peritumoral oedema is partly due to a vasogenic mechanism but also to a microscopic extension of sparse tumour cells. All these characteristics are not directly detectable using a conventional MR imaging (MRI). Complementary to the anatomical sequences (T1/T2), still always mandatory, functional maps using the dynamic MRI with a T2* weighted sequence reflect micro-vessel perfusion and permeability, more on a quantitative aspect and a qualitative one, respectively. These parameters better appreciate neo-vascularity of gliomas and areas associated with a higher value of perfusion are clearly correlated with a higher grade. Even a low-grade glioma but with detectable areas of high permeability presents a two-fold risk of recurrence versus another one with the same anatomical characteristics and treatment, but without any micro-vascular leakage. For high-grade gliomas, a high level of tissue perfusion seems to be better predictive for the risk of recurrence than histology itself. The exact co-registration of anatomic and vascular maps is currently available in clinical practice and can be incorporated during the dedicated brain MRI for radiotherapy. Its potential for better predicting the exact sites of recurrence after treatment has to be prospectively evaluated and a strong interest for a dose-escalating study is evident. Finally, T2* dynamic MRI has the ability to differentiate post-treatment modifications from recurrence better than conventional imaging.

[Radiation therapy and medical imaging]

The goal of radiation therapy is to deliver a high-dose of radiation to the tumour or target region to improve local control of disease and a low-dose to normal soft tissues to limit side effects. Conformal radiation therapy, intensity modulated radiotherapy (IMRT), brachytherapy and stereotactic radiosurgery have been developed to achieve the desired dose distribution. They require precise imaging of internal anatomy so that it is well adapted to the tumour and organs at risk. Indeed, morphological imaging such as computed tomography is already recommended for radiotherapy planning. But radiation oncologists are also considering other imaging modalities for treatment planning and imaging tools capable of controlling patient motion during treatment. The aim of this article is to present and illustrate the place of imaging during treatment planning and delivery via techniques such as: 4D computed tomography, morphological and functional MRI, positron emission tomography, and imaging devices mounted on accelerators.

An experimental study of acute radiation-induced cognitive dysfunction in a young rat model

BACKGROUND AND PURPOSE

Radiation-induced cognitive dysfunction is a common and serious clinical complication after radiation therapy for a brain tumor, but the knowledge of its mechanism is poorly understood. The purpose of this study was to establish a young rat model for acute radiation-induced cognitive dysfunction and associated BBB damage, as well as histopathologic changes.

MATERIALS AND METHODS

Young male rats were randomized into 4 groups to receive irradiation treatments at 300 cGy/min with doses of 0 (sham), 10, 20, and 40 Gy, respectively. Each treatment group was further randomized into 4 subgroups for following up cognitive tests and assessment of their BBB integrity and potential histopathologic changes at 0, 7, 20, and 60 days.

RESULTS

We found that irradiation at 10 Gy failed to induce any significant effects. Irradiation at 20 Gy resulted in a transient impairment of the cognitive functions at 7 and 20 days and returned to normal at 60 days. Irradiation at 40 Gy caused the severest cognitive impairment, which peaked at 7 days, and lasted for at least 60 days. The impaired cognition in both the 20-Gy and 40-Gy-irradiated rats was more or less accompanied with increased brain water content and deteriorated BBB function, though mild histopathologic alternations were only noticed in the 40-Gy-irradiated rats at 20 days.

CONCLUSION

A single-dose exposure at 20 to 40 Gy is sufficient to induce acute brain injury at both cognitive and pathologic levels in young male rats. In addition, morphologic outcomes may not be sensitive enough to reveal all of the pathologic changes, whereas BBB disruption may be an earlier and more sensitive index for acute RE. Therefore, the present model is useful for basic and therapeutic studies of acute RE.

[Proton magnetic resonance spectroscopic imaging and other types of metabolic imaging for radiotherapy planning in adult and pediatric high-grade gliomas]

Radiation therapy improves survival in high-grade gliomas but most patients relapse and usually within radiation fields. This may be due to uncertainties in target delineation and difficulties in identifying radioresistant regions for dose escalation. The use of T1 and T2-weighted magnetic resonance imaging (MRI) coregistration on the planning CT improves the target volume definition but magnetic resonance spectroscopic imaging (MRSI) and other types of metabolic and functional imaging (perfusion MRI, diffusion-weighted MRI, positron emission tomography (PET) imaging) may give useful additional information for target delineation. This article focuses on the potential of each imaging modality: assessment of response to treatment, detection of abnormalities not seen on MRI, predictive value for the site of local relapse. The incorporation of such techniques may improve target volume definition.