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Liang HKT, Chen WY, Lai SF, Su MY, You SL, Chen LH, Tseng HM, Chen CM, Kuo SH, Tseng WYI. The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas. Radiother Oncol 2017; 125:248-257. [PMID: 29056290 DOI: 10.1016/j.radonc.2017.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/10/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Irradiating glioblastoma preoperative edema (PE) remains controversial. We investigated the associations between tumors' PE extent with invasion into synchronous subventricular zone and corpus callosum (sSVZCC) and treatment outcomes to provide the clinical evidence for radiotherapy decision-making. MATERIAL AND METHODS Extensive PE (EPE) was defined as PE extending ≥2 cm from the tumor edge and extensive progressive disease (EPD) as tumors spreading ≥2 cm from the preoperative tumor edge along PE. The survival and progression patterns were analyzed according to EPE and sSVZCC invasion. RESULTS In total, 136 patients were followed for a median of 74.9 (range, 47.6-102.1) months. The median overall survival and progression-free survival were 19.7 versus 28.6 months (p = 0.005) and 11.0 versus 17.4 months (p = 0.011) in patients with EPE+ versus EPE-, and were 18.7 versus 25.4 months (p = 0.021) and 10.7 versus 14.6 months (p = 0.020) in those with sSVZCC+ versus sSVZCC-. The EPD rates for tumors with EPE-/sSVZCC-, EPE-/sSVZCC+, EPE+/sSVZCC-, and EPE+/sSVZCC+ were 2.8%, 7.1%, 37.0%, and 71.9%, respectively. In EPE+/sSVZCC+, tumor migration was associated with the PE extending along the corpus callosum (77.8%) and subventricular zone (50.0%). CONCLUSIONS Our results support the need for developing individualized irradiation strategies for glioblastomas according to EPE and sSVZCC.
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Affiliation(s)
- Hsiang-Kuang Tony Liang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Fan Lai
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - San-Lin You
- School of Medicine, College of Medicine, and Big Data Research Center, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Liang-Hsin Chen
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ham-Min Tseng
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-Ming Chen
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
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Pospisil P, Kazda T, Hynkova L, Bulik M, Dobiaskova M, Burkon P, Laack NN, Slampa P, Jancalek R. Post-WBRT cognitive impairment and hippocampal neuronal depletion measured by in vivo metabolic MR spectroscopy: Results of prospective investigational study. Radiother Oncol 2017; 122:373-379. [PMID: 28063694 DOI: 10.1016/j.radonc.2016.12.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 10/26/2016] [Accepted: 12/08/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this prospective study is to evaluate post-whole brain radiotherapy (WBRT) changes in hippocampal concentration of N-acetylaspartate (h-tNAA) as a marker of neuronal loss and to correlate those changes to neurocognitive function. MATERIAL AND METHODS Thirty-five patients with brain metastases underwent baseline single slice multi-voxel MR spectroscopy (MRS) examination for measurement of hippocampal h-tNAA together with baseline battery of neurocognitive tests focused on memory (Auditory Verbal Learning Test and Brief Visuospatial Memory Test - Revised) as well as quality of life questionnaires (EORTC QLQ-C30 a EORTC QLQ-BN20). Eighteen patients completed follow-up evaluation four months after standard WBRT (2 laterolateral fields, 10×3.0Gy, 6MV photons) and were included in this analysis. MRS and cognitive examinations were repeated and compared to baseline measurements. RESULTS Statistically significant decreases in h-tNAA were observed in the right (8.52-7.42mM; -12.9%, 95%CI: -7.6 to -16.4%) as well as in the left hippocampus (8.64-7.60mM; -12%, 95%CI: -7.9 to -16.2%). Statistically significant decline was observed in all AVLT and BVMT-R subtests with exception of AVLT_Recognition. Quality of life declined after WBRT (mean Δ -14.1±20.3 points in transformed 0-100 point scale; p=0.018) with no correlation to changes in hippocampal metabolite concentrations. Moderate positive correlation was observed between left h-tNAA concentration decrease and AVLT_TR decline (r=+0.32; p=0.24) as well as with AVLT_DR (r=+0.33; p=0.22) decline. Changes in right h-tNAA/Cr negatively correlated with AVLT_DR (r=-0.48; p=0.061). No correlation between right hippocampus h-tNAA and memory decline (AVLT) was observed. CONCLUSIONS Our results suggest hippocampal NAA concentrations decline after WBRT and MRS may be a useful biomarker for monitoring neuronal loss after radiotherapy.
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Affiliation(s)
- Petr Pospisil
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic
| | - Ludmila Hynkova
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Martin Bulik
- Department of Diagnostic Imaging, St. Anne's University Hospital Brno, Czech Republic
| | - Marie Dobiaskova
- Department of Clinical Psychology, St. Anne's University Hospital Brno, Czech Republic
| | - Petr Burkon
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Pavel Slampa
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery - St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Czech Republic; Department of Neurosurgery, St. Anne's University Hospital Brno, Czech Republic.
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