Organ culture of a glioblastoma from a patient with an unusually long survival

Long-Term Survival in Cerebral Glioblastoma. Case Report and Critical Review of the Literature

Glioblastoma multiforme is the most malignant tumor of the glial series. The average survival of patients with this tumor ranges from 6 to 12 months. The case of a patient who survived for more than 11 years after diagnosis of a temporal-occipital glioblastoma which was treated with surgery, radiotherapy and chemotherapy is described. The authors deduce that among patients with glioblastoma multiforme (GM), those with a long disease-free interval after initial diagnosis who undergo multimodal therapy, including aggressive tumor removal, are the most likely long-term survivors (LS). Other factors which appeared to be related to longer survival were younger age and high Karnofsky scores.

The influence of sex and the presence of giant cells on postoperative long-term survival in adult patients with supratentorial glioblastoma multiforme

OBJECT

Glioblastoma multiforme (GBM) remains incurable by conventional treatments, although some patients experience long-term survival. A younger age, a higher Karnofsky Performance Scale (KPS) score, more aggressive treatment, and long progression-free intervals have been reported to be positively associated with long-term postoperative patient survival. The aim of this retrospective study was the identification of additional favorable prognostic factors affecting long-term survival in surgically treated adult patients with supratentorial GBM.

METHODS

Of 113 adult patients newly diagnosed with histologically verified supratentorial GBM who were enrolled in Phase III trials during the period between 1987 and 1998, six (5.3%) who survived for longer than 5 years were defined as long-term survivors, whereas the remaining 107 patients served as controls. All six were women and were compared with the controls; they were younger (mean age 44.2 years, range 31-60 years), and their preoperative KPS scores were higher (mean 85, range 60-100). Four of the six patients underwent gross-total resection. In five patients (83.3%) the progression-free interval was longer than 5 years and in three a histopathological diagnosis of giant cell GBM was made. This diagnosis was not made in the other 107 patients.

CONCLUSIONS

Among adult patients with supratentorial GBM, female sex and histopathological characteristics consistent with giant cell GBM may be predictive of a better survival rate, as may traditional factors (that is, younger age, good KPS score, more aggressive resection, and a long progression-free interval).

Invasion of human glioma biopsy specimens in cultures of rodent brain slices: a quantitative analysis

OBJECT

The reliable assessment of the invasiveness of gliomas in vitro has proved elusive, because most invasion assays inadequately model in vivo invasion in its complexity. Recently, organotypical brain cultures were successfully used in short-term invasion studies on glioma cell lines. In this paper the authors report that the invasiveness of human glioma biopsy specimens directly implanted into rodent brain slices by using the intraslice implantation system (ISIS) can be quantified with precision. The model was first validated by the demonstration that, in long-term studies, established glioma cells survive in the ISIS and follow pathways of invasion similar to those in vivo.

METHODS

Brain slices (400 microm thick) from newborn mice were maintained on millicell membranes for 15 days. Cells from two human and one rodent glioblastoma multiforme (GBM) cell lines injected into the ISIS were detected by immunohistochemistry or after transfection with green fluorescent protein-containing vectors. Preferential migration along blood vessels was identified using confocal and fluorescent microscopy. Freshly isolated (< or = 24 hours after removal) 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate-prelabeled human glioma biopsy specimens were successfully implanted in 19 (83%) of 23 cases, including 12 GBMs and seven lower grade gliomas (LGGs). Morphometric quantification of distance and density of tumor cell invasion showed that the GBMs were two to four times more invasive than the LGGs. Heterogeneity of invasion was also observed among GBMs and LGGs. Directly implanted glioma fragments were more invasive than spheroids derived from the same biopsy specimen.

CONCLUSIONS

The ISIS combines a high success rate, technical simplicity, and detailed quantitative measurements and may, therefore, be used to study the invasiveness of biopsy specimens of gliomas of different grades.

Local spread of malignant neuroepithelial tumors

A short review of invasiveness of primary malignant neoplasms in the nervous system is given. Invasiveness implies progressive spread and destruction locally, which eventually leads to a fatal outcome in the patient. In particular, the malignant cells are able to rapidly migrate over large parts of the brain. This process includes the capacity to adhere to a substratum, usually constituted by the various components of the extracellular matrix, followed by detachment and migration. Anatomical structures and local regulatory factors in the brain influence the direction and extent of this migration. Several model systems are now available for monitoring the aggressiveness of such tumours both in vivo and in vitro, and different phenotypic properties characteristic of invasive cells have been elucidated. Although still in its infancy, and currently as an experimental approach, anti-invasive therapy may in the future be an interesting alternative to conventional chemotherapy of brain tumours.