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Jiao C, Lao Y, Zhang W, Braunstein S, Salans M, Villanueva-Meyer J, Hervey-Jumper SL, Yang B, Morin O, Valdes G, Fan Z, Shiroishi M, Zada G, Sheng K, Yang W. Multi-modal fusion and feature enhancement U-Net coupling with stem cell niches proximity estimation for voxel-wise GBM recurrence prediction . Phys Med Biol 2024; 69:155021. [PMID: 39019073 DOI: 10.1088/1361-6560/ad64b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 07/17/2024] [Indexed: 07/19/2024]
Abstract
Objective.We aim to develop a Multi-modal Fusion and Feature Enhancement U-Net (MFFE U-Net) coupling with stem cell niche proximity estimation to improve voxel-wise Glioblastoma (GBM) recurrence prediction.Approach.57 patients with pre- and post-surgery magnetic resonance (MR) scans were retrospectively solicited from 4 databases. Post-surgery MR scans included two months before the clinical diagnosis of recurrence and the day of the radiologicaly confirmed recurrence. The recurrences were manually annotated on the T1ce. The high-risk recurrence region was first determined. Then, a sparse multi-modal feature fusion U-Net was developed. The 50 patients from 3 databases were divided into 70% training, 10% validation, and 20% testing. 7 patients from the 4th institution were used as external testing with transfer learning. Model performance was evaluated by recall, precision, F1-score, and Hausdorff Distance at the 95% percentile (HD95). The proposed MFFE U-Net was compared to the support vector machine (SVM) model and two state-of-the-art neural networks. An ablation study was performed.Main results.The MFFE U-Net achieved a precision of 0.79 ± 0.08, a recall of 0.85 ± 0.11, and an F1-score of 0.82 ± 0.09. Statistically significant improvement was observed when comparing MFFE U-Net with proximity estimation couple SVM (SVMPE), mU-Net, and Deeplabv3. The HD95 was 2.75 ± 0.44 mm and 3.91 ± 0.83 mm for the 10 patients used in the model construction and 7 patients used for external testing, respectively. The ablation test showed that all five MR sequences contributed to the performance of the final model, with T1ce contributing the most. Convergence analysis, time efficiency analysis, and visualization of the intermediate results further discovered the characteristics of the proposed method.Significance. We present an advanced MFFE learning framework, MFFE U-Net, for effective voxel-wise GBM recurrence prediction. MFFE U-Net performs significantly better than the state-of-the-art networks and can potentially guide early RT intervention of the disease recurrence.
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Affiliation(s)
- Changzhe Jiao
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Yi Lao
- Department of Radiation Oncology, UC Los Angeles, Los Angeles, CA 90095, United States of America
| | - Wenwen Zhang
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Steve Braunstein
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Mia Salans
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Javier Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Shawn L Hervey-Jumper
- Department of Neurosurgery, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Bo Yang
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Olivier Morin
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Gilmer Valdes
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Zhaoyang Fan
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Mark Shiroishi
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Ke Sheng
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
| | - Wensha Yang
- Department of Radiation Oncology, UC San Francisco, San Francisco, CA 94143, United States of America
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Zhao K, Liu R, Li Z, Liu M, Zhao Y, Xue Z, Wu W, Sun G, Xu B. The imaging features and prognosis of gliomas involving the subventricular zone: An MRI study. Clin Neurol Neurosurg 2022; 222:107465. [DOI: 10.1016/j.clineuro.2022.107465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/26/2022]
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Lao Y, Ruan D, Vassantachart A, Fan Z, Ye JC, Chang EL, Chin R, Kaprealian T, Zada G, Shiroishi MS, Sheng K, Yang W. Voxelwise Prediction of Recurrent High-Grade Glioma via Proximity Estimation-Coupled Multidimensional Support Vector Machine. Int J Radiat Oncol Biol Phys 2022; 112:1279-1287. [PMID: 34963559 PMCID: PMC8923952 DOI: 10.1016/j.ijrobp.2021.12.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To provide early and localized glioblastoma (GBM) recurrence prediction, we introduce a novel postsurgery multiparametric magnetic resonance-based support vector machine (SVM) method coupling with stem cell niche (SCN) proximity estimation. METHODS AND MATERIALS This study used postsurgery magnetic resonance imaging (MRI) scans from 50 patients with recurrent GBM, obtained approximately 2 months before clinically diagnosed recurrence. The main prediction pipeline consisted of a proximity-based estimator to identify regions with high risk of recurrence (HRRs) and an SVM classifier to provide voxelwise prediction in HRRs. The HRRs were estimated using the weighted sum of inverse distances to 2 possible origins of recurrence-the SCN and the tumor cavity. Subsequently, multiparametric voxels (from T1, T1 contrast-enhanced, fluid-attenuated inversion recovery, T2, and apparent diffusion coefficient) within the HRR were grouped into recurrent (warped from the clinical diagnosis) and nonrecurrent subregions and fed into the proximity estimation-coupled SVM classifier (SVMPE). The cohort was randomly divided into 40% and 60% for training and testing, respectively. The trained SVMPE was then extrapolated to an earlier time point for earlier recurrence prediction. As an exploratory analysis, the SVMPE predictive cluster sizes and the image intensities from the 5 magnetic resonance sequences were compared across time to assess the progressive subclinical traces. RESULTS On 2-month prerecurrence MRI scans from 30 test cohort patients, the SVMPE classifier achieved a recall of 0.80, a precision of 0.69, an F1-score of 0.73, and a mean boundary distance of 7.49 mm. Exploratory analysis at early time points showed spatially consistent but significantly smaller subclinical clusters and significantly increased T1 contrast-enhanced and apparent diffusion coefficient values over time. CONCLUSIONS We demonstrated a novel voxelwise early prediction method, SVMPE, for GBM recurrence based on clinical follow-up MR scans. The SVMPE is promising in localizing subclinical traces of recurrence 2 months ahead of clinical diagnosis and may be used to guide more effective personalized early salvage therapy.
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Affiliation(s)
- Yi Lao
- Department of Radiation Oncology, University of California - Los Angeles, USA
| | - Dan Ruan
- Department of Radiation Oncology, University of California - Los Angeles, USA
| | - April Vassantachart
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, USA
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, USA
| | - Jason C. Ye
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, USA
| | - Eric L. Chang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, USA
| | - Robert Chin
- Department of Radiation Oncology, University of California - Los Angeles, USA
| | - Tania Kaprealian
- Department of Radiation Oncology, University of California - Los Angeles, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, USA
| | - Mark S Shiroishi
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, USA
| | - Ke Sheng
- Department of Radiation Oncology, University of California - Los Angeles, USA
| | - Wensha Yang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, USA
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Soares LC, Al-Dalahmah O, Hillis J, Young CC, Asbed I, Sakaguchi M, O’Neill E, Szele FG. Novel Galectin-3 Roles in Neurogenesis, Inflammation and Neurological Diseases. Cells 2021; 10:3047. [PMID: 34831271 PMCID: PMC8618878 DOI: 10.3390/cells10113047] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
Galectin-3 (Gal-3) is an evolutionarily conserved and multifunctional protein that drives inflammation in disease. Gal-3's role in the central nervous system has been less studied than in the immune system. However, recent studies show it exacerbates Alzheimer's disease and is upregulated in a large variety of brain injuries, while loss of Gal-3 function can diminish symptoms of neurodegenerative diseases such as Alzheimer's. Several novel molecular pathways for Gal-3 were recently uncovered. It is a natural ligand for TREM2 (triggering receptor expressed on myeloid cells), TLR4 (Toll-like receptor 4), and IR (insulin receptor). Gal-3 regulates a number of pathways including stimulation of bone morphogenetic protein (BMP) signaling and modulating Wnt signalling in a context-dependent manner. Gal-3 typically acts in pathology but is now known to affect subventricular zone (SVZ) neurogenesis and gliogenesis in the healthy brain. Despite its myriad interactors, Gal-3 has surprisingly specific and important functions in regulating SVZ neurogenesis in disease. Gal-1, a similar lectin often co-expressed with Gal-3, also has profound effects on brain pathology and adult neurogenesis. Remarkably, Gal-3's carbohydrate recognition domain bears structural similarity to the SARS-CoV-2 virus spike protein necessary for cell entry. Gal-3 can be targeted pharmacologically and is a valid target for several diseases involving brain inflammation. The wealth of molecular pathways now known further suggest its modulation could be therapeutically useful.
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Affiliation(s)
- Luana C. Soares
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, South Parks Road, Oxford OX1 3QX, UK; (L.C.S.); (I.A.)
- Department of Oncology, University of Oxford, Oxford OX1 3QX, UK;
| | - Osama Al-Dalahmah
- Irving Medical Center, Columbia University, New York, NY 10032, USA;
| | - James Hillis
- Massachusets General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA;
| | - Christopher C. Young
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA;
| | - Isaiah Asbed
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, South Parks Road, Oxford OX1 3QX, UK; (L.C.S.); (I.A.)
| | - Masanori Sakaguchi
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba 305-8575, Japan;
| | - Eric O’Neill
- Department of Oncology, University of Oxford, Oxford OX1 3QX, UK;
| | - Francis G. Szele
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, South Parks Road, Oxford OX1 3QX, UK; (L.C.S.); (I.A.)
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The Role of SVZ Stem Cells in Glioblastoma. Cancers (Basel) 2019; 11:cancers11040448. [PMID: 30934929 PMCID: PMC6521108 DOI: 10.3390/cancers11040448] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/27/2022] Open
Abstract
As most common primary brain cancer, glioblastoma is also the most aggressive and malignant form of cancer in the adult central nervous system. Glioblastomas are genetic and transcriptional heterogeneous tumors, which in spite of intensive research are poorly understood. Over the years conventional therapies failed to affect a cure, resulting in low survival rates of affected patients. To improve the clinical outcome, an important approach is to identify the cells of origin. One potential source for these are neural stem cells (NSCs) located in the subventricular zone, which is one of two niches in the adult nervous system where NSCs with the capacity of self-renewal and proliferation reside. These cells normally give rise to neuronal as well as glial progenitor cells. This review summarizes current findings about links between NSCs and cancer stem cells in glioblastoma and discusses current therapeutic approaches, which arise as a result of identifying the cell of origin in glioblastoma.
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Location-Dependent Patient Outcome and Recurrence Patterns in IDH1-Wildtype Glioblastoma. Cancers (Basel) 2019; 11:cancers11010122. [PMID: 30669568 PMCID: PMC6356480 DOI: 10.3390/cancers11010122] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/31/2022] Open
Abstract
Recent studies suggest that glioblastomas (GBMs) contacting the subventricular zone (SVZ) as the main adult neurogenic niche confer a dismal prognosis but disregard the unique molecular and prognostic phenotype associated with isocitrate dehydrogenase 1 (IDH1) mutations. We therefore examined location-dependent prognostic factors, growth, and recurrence patterns in a consecutive cohort of 285 IDH1-wildtype GBMs. Based on pre-operative contrast-enhanced MRI, patients were allotted to four location-dependent groups with (SVZ+; groups I, II) and without (SVZ-; groups III, IV) SVZ involvement or with (cortex+; groups I, III) and without (cortex-; groups II, IV) cortical involvement and compared for demographic, treatment, imaging, and survival data at first diagnosis and recurrence. SVZ involvement was associated with lower Karnofsky performance score (p < 0.001), lower frequency of complete resections at first diagnosis (p < 0.0001), and lower non-surgical treatment intensity at recurrence (p < 0.001). Multivariate survival analysis employing a Cox proportional hazards model identified SVZ involvement as an independent prognosticator of inferior overall survival (p < 0.001) and survival after relapse (p = 0.041). In contrast, multifocal growth at first diagnosis (p = 0.031) and recurrence (p < 0.001), as well as distant recurrences (p < 0.0001), was more frequent in cortex+ GBMs. These findings offer the prospect for location-tailored prognostication and treatment based on factors assessable on pre-operative MRI.
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Murchison SC, Wiksyk B, Gossman S, Jensen B, Sayers D, Lesperance M, Truong PT, Alexander A. Subventricular Zone Radiation Dose and Outcome for Glioblastoma Treated Between 2006 and 2012. Cureus 2018; 10:e3618. [PMID: 30697499 PMCID: PMC6347443 DOI: 10.7759/cureus.3618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Stem cells residing in the subventricular zone (SVZ) may be related to recurrence, potentially affecting outcome in glioblastoma (GBM). This study investigated the relationship of SVZ radiation dose and survival in a large cohort treated with surgery and chemoradiotherapy (CRT). Methods Patients with GBM treated between 2006 and 2012 (n = 370) were identified. SVZs were contoured from planning computed tomography (CT) with magnetic resonance imaging (MRI) registration where available. Dose was extracted from dose volume histograms. Kaplan-Meier (KM) progression-free survival (PFS) and overall survival (OS) estimates were compared with log-rank tests for SVZ doses. Multivariate analysis (MVA) identified clinical and treatment-related factors significantly associated with outcome. Results Median follow-up was 16.4 months, 48.1% underwent gross total resection (GTR), 37.5% subtotal resection, and 14.4% biopsy without resection. Median PFS was 8.9 months (95% CI: 8.3-9.8 months), and OS was 16.5 months (95% CI: 15.2-17.6 months). PFS was significantly lower for older age (>50 years, P = 0.045), poor Karnofsky performance status (KPS, P = 0.049), multifocality (P < 0.001), and incomplete adjuvant chemotherapy (P < 0.001). Worse OS was associated with poor KPS (P = 0.001), biopsy only (P = 0.003), multifocality (P = 0.009), and failure to complete adjuvant chemotherapy (P < 0.001). SVZ dose was not associated with outcome for any of the dose levels assessed. On MVA, multifocality was associated with worse PFS (P < 0.01). Poor performance status and biopsy only were associated with worse OS (both P < 0.01). Conclusion In this analysis of a large cohort of GBM treated with surgery and CRT, increased SVZ dose was not associated with improved survival.
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Affiliation(s)
- Sonja C Murchison
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Bradley Wiksyk
- Internal Medicine, University of British Columbia, Vancouver, CAN
| | - Stacey Gossman
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Brigit Jensen
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Dorothy Sayers
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | | | - Pauline T Truong
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Abraham Alexander
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
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Bardella C, Al-Shammari AR, Soares L, Tomlinson I, O'Neill E, Szele FG. The role of inflammation in subventricular zone cancer. Prog Neurobiol 2018; 170:37-52. [PMID: 29654835 DOI: 10.1016/j.pneurobio.2018.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/10/2018] [Accepted: 04/07/2018] [Indexed: 12/12/2022]
Abstract
The adult subventricular zone (SVZ) stem cell niche has proven vital for discovering neurodevelopmental mechanisms and holds great potential in medicine for neurodegenerative diseases. Yet the SVZ holds a dark side - it can become tumorigenic. Glioblastomas can arise from the SVZ via cancer stem cells (CSCs). Glioblastoma and other brain cancers often have dismal prognoses since they are resistant to treatment. In this review we argue that the SVZ is susceptible to cancer because it contains stem cells, migratory progenitors and unusual inflammation. Theoretically, SVZ stem cells can convert to CSCs more readily than can postmitotic neural cells. Additionally, the robust long-distance migration of SVZ progenitors can be subverted upon tumorigenesis to an infiltrative phenotype. There is evidence that the SVZ, even in health, exhibits chronic low-grade cellular and molecular inflammation. Its inflammatory response to brain injuries and disease differs from that of other brain regions. We hypothesize that the SVZ inflammatory environment can predispose cells to novel mutations and exacerbate cancer phenotypes. This can be studied in animal models in which human mutations related to cancer are knocked into the SVZ to induce tumorigenesis and the CSC immune interactions that precede full-blown cancer. Importantly inflammation can be pharmacologically modulated providing an avenue to brain cancer management and treatment. The SVZ is accessible by virtue of its location surrounding the lateral ventricles and CSCs in the SVZ can be targeted with a variety of pharmacotherapies. Thus, the SVZ can yield aggressive tumors but can be targeted via several strategies.
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Affiliation(s)
- Chiara Bardella
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK
| | - Abeer R Al-Shammari
- Research and Development, Qatar Research Leadership Program, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Luana Soares
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK
| | - Eric O'Neill
- Department of Oncology, University of Oxford, Oxford, UK
| | - Francis G Szele
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
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Mann J, Ramakrishna R, Magge R, Wernicke AG. Advances in Radiotherapy for Glioblastoma. Front Neurol 2018; 8:748. [PMID: 29379468 PMCID: PMC5775505 DOI: 10.3389/fneur.2017.00748] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/27/2017] [Indexed: 11/13/2022] Open
Abstract
External beam radiotherapy (RT) has long played a crucial role in the treatment of glioblastoma. Over the past several decades, significant advances in RT treatment and image-guidance technology have led to enormous improvements in the ability to optimize definitive and salvage treatments. This review highlights several of the latest developments and controversies related to RT, including the treatment of elderly patients, who continue to be a fragile and vulnerable population; potential salvage options for recurrent disease including reirradiation with chemotherapy; the latest imaging techniques allowing for more accurate and precise delineation of treatment volumes to maximize the therapeutic ratio of conformal RT; the ongoing preclinical and clinical data regarding the combination of immunotherapy with RT; and the increasing evidence of cancer stem-cell niches in the subventricular zone which may provide a potential target for local therapies. Finally, continued development on many fronts have allowed for modestly improved outcomes while at the same time limiting toxicity.
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Affiliation(s)
- Justin Mann
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Rajiv Magge
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - A Gabriella Wernicke
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
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Attal J, Chaltiel L, Lubrano V, Sol JC, Lanaspeze C, Vieillevigne L, Latorzeff I, Cohen-Jonathan Moyal E. Subventricular zone involvement at recurrence is a strong predictive factor of outcome following high grade glioma reirradiation. J Neurooncol 2017; 136:413-419. [PMID: 29273890 DOI: 10.1007/s11060-017-2669-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
We aimed to assess the efficacy of stereotactic irradiation for patients with recurrent high-grade glioma (HGG) and identify predictive factors of progression-free survival (PFS) and overall survival (OS) following reirradiation. We identified 32 patients with recurrent brain HGG who had been treated with either single-dose (stereotactic radiosurgery) or fractionated stereotactic radiotherapy between April 2008 and October 2015. Median follow up was 21.4 months (range 12.9-23.2) and median PFS was and 3.3 months (95% CI [2.3-4.7]), respectively. OS was 90.40% (95% CI [73.09-96.80]) at 6 months and 79.55% (95% CI [59.9-90.29]) at 12 months. Univariate analysis showed that biological effective dose at isocenter ≤ 76 Gy was a poor prognostic factor for both OS (83.33 vs. 100% at 6 months, p = 0.032) and median PFS (2.7 vs. 4.7 months, p = 0.025), as was gross tumor volume (GTV) above 1 cm3 for OS (86.15 vs. 94.12% at 6 months, p = 0.043). Contact with the subventricular zone (SVZ) was also a poor prognostic factor for median PFS (2.3 vs. 4.7 months, p = 0.002). Multivariate analysis showed that SVZ contact remained a poor prognostic factor for PFS (hazard ratio = 3.44, 95% CI [1.21-9.82], p = 0.021). Results suggest that reirradiation is a safe and effective treatment option for recurrent HGG in patients with a good Karnosfsky Performance Scale score, a long progression-free interval since first radiation and limited GTV, and that contact to SVZ is a strong prognostic factor for PFS.
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Affiliation(s)
- J Attal
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France.
| | - L Chaltiel
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - V Lubrano
- Regional Center for Stereotactic Radiosurgery, CHU Rangueil, Avenue Jean-Poulhès, 31052, Toulouse, France
- Department of Neurosurgery, CHU de Toulouse, Université Paul-Sabatier, 31059, Toulouse, France
| | - J C Sol
- Department of Neurosurgery, CHU de Toulouse, Université Paul-Sabatier, 31059, Toulouse, France
| | - C Lanaspeze
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - L Vieillevigne
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - I Latorzeff
- Regional Center for Stereotactic Radiosurgery, CHU Rangueil, Avenue Jean-Poulhès, 31052, Toulouse, France
- Department of Oncology-Radiotherapy, Groupe ONCORAD Garonne, Clinique Pasteur, 31300, Toulouse, France
| | - E Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), 31000, Toulouse, France
- Université Toulouse III Paul Sabatier, 31300, Toulouse, France
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Khalifa J, Tensaouti F, Lusque A, Plas B, Lotterie JA, Benouaich-Amiel A, Uro-Coste E, Lubrano V, Cohen-Jonathan Moyal E. Subventricular zones: new key targets for glioblastoma treatment. Radiat Oncol 2017; 12:67. [PMID: 28424082 PMCID: PMC5397708 DOI: 10.1186/s13014-017-0791-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/24/2017] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to identify subventricular zone (SVZ)-related prognostic factors of survival and patterns of recurrence among patients with glioblastoma. Methods Forty-three patients with primary diagnosed glioblastoma treated in our Cancer Center between 2006 and 2010 were identified. All patients received surgical resection, followed by temozolomide-based chemoradiation. Ipsilateral (iSVZ), contralateral (cSVZ) and bilateral (bSVZ) SVZs were retrospectively segmented and radiation dose-volume histograms were generated. Multivariate analysis using the Cox proportional hazards model was assessed to examine the relationship between prognostic factors and time to progression (TTP) or overall survival (OS). Results Median age was 59 years (range: 25–85). Median follow-up, OS and TTP were 22.7 months (range 7.5–69.7 months), 22.7 months (95% CI 14.5–26.2 months) and 6.4 months (95% CI 4.4–9.3 months), respectively. On univariate analysis, initial contact to SVZ was a poor prognostic factor for OS (18.7 vs 41.7 months, p = 0.014) and TTP (4.6 vs 12.9 months, p = 0.002). Patients whose bSVZ volume receiving at least 20 Gy (V20Gy) was greater than 84% had a significantly improved TTP (17.7 months vs 5.2 months, p = 0.017). This radiation dose coverage was compatible with an hippocampal sparing. On multivariate analysis, initial contact to SVZ and V20 Gy to bSVZ lesser than 84% remained poor prognostic factors for TTP (HR = 3.07, p = 0.012 and HR = 2.67, p = 0.047, respectively). Conclusion Our results suggest that contact to SVZ, as well as insufficient bSVZ radiation dose coverage (V20Gy <84%), might be independent poor prognostic factors for TTP. Therefore, targeting SVZ could be of crucial interest for optimizing glioblastoma treatment.
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Affiliation(s)
- J Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.
| | - F Tensaouti
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France
| | - A Lusque
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - B Plas
- Department of Neurosurgery, Institut Universitaire du Cancer de Toulouse - Purpan, Place du Docteur Baylac, Toulouse Cedex, 31059, France
| | - J-A Lotterie
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, CHU Rangueil, 1 avenue du Pr Jean Poulhès TSA 50032, Toulouse Cedex, 31059, France
| | - A Benouaich-Amiel
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - E Uro-Coste
- Department of Pathology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.,Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.,INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - V Lubrano
- Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France.,Department of Neurosurgery, Institut Universitaire du Cancer de Toulouse - Purpan, Place du Docteur Baylac, Toulouse Cedex, 31059, France
| | - E Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.,Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.,INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
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12
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Foro Arnalot P, Pera O, Rodriguez N, Sanz X, Reig A, Membrive I, Ortiz A, Granados R, Algara M. Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide. Clin Transl Oncol 2017; 19:1225-1231. [PMID: 28389881 DOI: 10.1007/s12094-017-1659-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/31/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide. METHODS AND MATERIALS Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide. RESULTS Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203). CONCLUSION High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme.
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Affiliation(s)
- P Foro Arnalot
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
| | - O Pera
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - N Rodriguez
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - X Sanz
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - A Reig
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - I Membrive
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - A Ortiz
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - R Granados
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - M Algara
- Department of Radiation Oncology, Parc de Salut Mar, Sant Josep de la Montanya 12, 08024, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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13
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Mahase S, Rattenni RN, Wesseling P, Leenders W, Baldotto C, Jain R, Zagzag D. Hypoxia-Mediated Mechanisms Associated with Antiangiogenic Treatment Resistance in Glioblastomas. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:940-953. [PMID: 28284719 DOI: 10.1016/j.ajpath.2017.01.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 12/28/2022]
Abstract
Glioblastomas (GBMs) are malignant tumors characterized by their vascularity and invasive capabilities. Antiangiogenic therapy (AAT) is a treatment option that targets GBM-associated vasculature to mitigate the growth of GBMs. However, AAT demonstrates transient effects because many patients eventually develop resistance to this treatment. Several recent studies attempt to explain the molecular and biochemical basis of resistance to AAT in GBM patients. Experimental investigations suggest that the induction of extensive intratumoral hypoxia plays a key role in GBM escape from AAT. In this review, we examine AAT resistance in GBMs, with an emphasis on six potential hypoxia-mediated mechanisms: enhanced invasion and migration, including increased expression of matrix metalloproteinases and activation of the c-MET tyrosine kinase pathway; shifts in cellular metabolism, including up-regulation of hypoxia inducible factor-1α's downstream processes and the Warburg effect; induction of autophagy; augmentation of GBM stem cell self-renewal; possible implications of GBM-endothelial cell transdifferentiation; and vasoformative responses, including vasculogenesis, alternative angiogenic pathways, and vascular mimicry. Juxtaposing recent studies on well-established resistance pathways with that of emerging mechanisms highlights the overall complexity of GBM treatment resistance while also providing direction for further investigation.
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Affiliation(s)
- Sean Mahase
- Microvascular and Molecular Neuro-Oncology Laboratory, New York University School of Medicine, New York, New York
| | - Rachel N Rattenni
- Microvascular and Molecular Neuro-Oncology Laboratory, New York University School of Medicine, New York, New York
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center, Utrecht, the Netherlands
| | - William Leenders
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Clarissa Baldotto
- Medical Oncology, Instituto Nacionale de Cancer, Rio de Janeiro, Brazil
| | - Rajan Jain
- Department of Radiology, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - David Zagzag
- Microvascular and Molecular Neuro-Oncology Laboratory, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York; Division of Neuropathology, Department of Pathology, New York University School of Medicine, New York, New York; Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York.
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14
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Achari R, Arunsingh M, Badgami RK, Saha A, Chatterjee S, Shrimali RK, Mallick I, Arun B. High-dose Neural Stem Cell Radiation May Not Improve Survival in Glioblastoma. Clin Oncol (R Coll Radiol) 2017; 29:335-343. [PMID: 28188088 DOI: 10.1016/j.clon.2017.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 01/07/2023]
Abstract
AIMS To evaluate the effect of radiotherapy dose-volume parameters of neural stem cell (NSC) compartment on progression-free survival (PFS) and overall survival after post-resection chemoradiation in newly diagnosed glioblastoma. MATERIALS AND METHODS Sixty-one patients with unifocal glioblastoma were included. Ipsilateral (NSC_Ipsi), contralateral (NSC_Contra) and combined NSC (NSC_Combined) were contoured on radiotherapy planning computerised tomography datasets. NSC dose-volume parameters were correlated with PFS and overall survival. Serial magnetic resonance imaging scans were assessed to understand the frequency of pre- and post-treatment involvement of the NSC by contrast enhancing lesions (CELs). RESULTS Baseline involvement of NSC with CELs was seen in 67.2% and 95.9% had CELs and FLAIR abnormalities at progression. With a median follow-up of 14.1 months (interquartile range 9.4-20.6 months), median PFS and overall survival were 14.5 (95% confidence interval 11.6-17.5) and 16.2 (95% confidence interval 13.3-19.2) months, respectively. Poor Eastern Cooperative Oncology Group performance score, advanced recursive partitioning analysis class, unmethylated O6-methylguanine methyltransferase (MGMT) status, higher than median of mean NSC_Ipsi dose were associated with significantly inferior PFS and overall survival on univariate analysis. On multivariate analysis, unmethylated MGMT status, higher than median of mean doses to NSC_Ipsi and poor compliance to adjuvant temozolomide were independent predictors of inferior survival. CONCLUSIONS In this cohort, 67.2% of newly diagnosed glioblastoma patients had NSC involved with CELs at presentation and 95.9% at progression. This might be an imaging surrogate of the current notion of gliomagenesis and progression from NSC rests. A high radiation dose to NSC_Ipsi was significantly associated with inferior survival. This could be a function of larger tumours and planning target volumes in those with pre-treatment NSC involvement. Methylated MGMT and good compliance to adjuvant temozolomide were independent predictors of better survival. Until further evidence brings hope for glioblastoma, elective, partial NSC irradiation remains experimental.
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Affiliation(s)
- R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R K Badgami
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - A Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Medical Physics, Tata Medical Center, Kolkata, India
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15
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John JK, Robin AM, Pabaney AH, Rammo RA, Schultz LR, Sadry NS, Lee IY. Complications of ventricular entry during craniotomy for brain tumor resection. J Neurosurg 2016; 127:426-432. [PMID: 27813467 DOI: 10.3171/2016.7.jns16340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent studies have demonstrated that periventricular tumor location is associated with poorer survival and that tumor location near the ventricle limits the extent of resection. This finding may relate to the perception that ventricular entry leads to further complications and thus surgeons may choose to perform less aggressive resection in these areas. However, there is little support for this view in the literature. This study seeks to determine whether ventricular entry is associated with more complications during craniotomy for brain tumor resection. METHODS A retrospective analysis of patients who underwent craniotomy for tumor resection at Henry Ford Hospital between January 2010 and November 2012 was conducted. A total of 183 cases were reviewed with attention to operative entry into the ventricular system, postoperative use of an external ventricular drain (EVD), subdural hematoma, hydrocephalus, and symptomatic intraventricular hemorrhage (IVH). RESULTS Patients in whom the ventricles were entered had significantly higher rates of any complication (46% vs 21%). Complications included development of subdural hygroma, subdural hematoma, intraventricular hemorrhage, subgaleal collection, wound infection, urinary tract infection/deep venous thrombosis, hydrocephalus, and ventriculoperitoneal (VP) shunt placement. Specifically, these patients had significantly higher rates of EVD placement (23% vs 1%, p < 0.001), hydrocephalus (6% vs 0%, p = 0.03), IVH (14% vs 0%, p < 0.001), infection (15% vs 5%, p = 0.04), and subgaleal collection (20% vs 4%, p < 0.001). It was also observed that VP shunt placement was only seen in cases of ventricular entry (11% vs 0%, p = 0.001) with 3 of 4 of these patients having a large ventricular entry (defined here as entry greater than a pinhole [< 3 mm] entry). Furthermore, in a subset of glioblastoma patients with and without ventricular entry, Kaplan-Meier estimates for survival demonstrated a median survival time of 329 days for ventricular entry compared with 522 days for patients with no ventricular entry (HR 1.13, 95% CI 0.65-1.96; p = 0.67). CONCLUSIONS There are more complications associated with ventricular entry during brain tumor resection than in nonviolated ventricular systems. Better strategies for management of periventricular tumor resection should be actively sought to improve resection and survival for these patients.
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Affiliation(s)
- Jessin K John
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Adam M Robin
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Aqueel H Pabaney
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Richard A Rammo
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Lonni R Schultz
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Neema S Sadry
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Ian Y Lee
- Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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16
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Smith AW, Parashar B, Wernicke AG. Subventricular zone-associated glioblastoma: A call for translational research to guide clinical decision making. NEUROGENESIS 2016; 3:e1225548. [PMID: 27900341 DOI: 10.1080/23262133.2016.1225548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
Glioblastoma (GBM) is both the most common and the most devastating primary cancer of the central nervous system, with an expected overall survival in most patients of about 14 months. Despite extensive research, outcomes for GBM have been largely unchanged since the introduction of temozolomide in 2005. We believe that in order to achieve a breakthrough in therapeutic management, we must begin to identify subtypes of GBM, and tailor treatment to best target a particular tumor's vulnerabilities. Our group has recently produced an examination of the clinical outcomes of radiation therapy directed at tumors that contact the subventricular zone (SVZ), the 3-5 mm lateral border of the lateral ventricles that contains the largest collection of neural stem cells in the adult brain. We find that SVZ-associated tumors have worse progression free and overall survival than tumors that do not contact the SVZ, and that they exhibit unique recurrence and migration patterns. However, with minimal basic science research into SVZ-associated GBM, it is currently impossible to determine if the clinicobehavioral uniqueness of this group of tumors represents a true disease subtype from a genetic perspective. We believe that further translational research into SVZ-associated GBM is needed to establish a therapeutic profile.
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Affiliation(s)
- Andrew W Smith
- University of Rochester School of Medicine and Dentistry , Rochester, NY, USA
| | - Bhupesh Parashar
- Stitch Radiation Oncology, Weill-Cornell Medical College/New York Presbyterian Hospital , New York, NY, USA
| | - A Gabriella Wernicke
- Stitch Radiation Oncology, Weill-Cornell Medical College/New York Presbyterian Hospital , New York, NY, USA
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17
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Neural stem cells, the subventricular zone and radiotherapy: implications for treating glioblastoma. J Neurooncol 2016; 128:207-16. [PMID: 27108274 DOI: 10.1007/s11060-016-2123-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/07/2016] [Indexed: 02/08/2023]
Abstract
Over the past decade, advances in neuroscience have suggested that neural stem cells resident in specific regions of the adult brain may be involved in development of both primary and recurrent glioblastoma. Neurogenesis and malignant transformation occurs in the subventricular zone adjacent to the lateral ventricles. This region holds promise as a potential target for therapeutic intervention with radiotherapy. However, irradiation of a larger brain volume is not without risk, and significant side effects have been observed. The current literature remains contradictory regarding the efficacy of deliberate intervention with radiation to the subventricular zone. This critical review discusses the connection between neural stem cells and development of glioblastoma, explores the behavior of tumors associated with the subventricular zone, summarizes the discordant literature with respect to the effects of irradiation, and reviews other targeted therapies to this intriguing region.
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18
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Hira VVV, Ploegmakers KJ, Grevers F, Verbovšek U, Silvestre-Roig C, Aronica E, Tigchelaar W, Turnšek TL, Molenaar RJ, Van Noorden CJF. CD133+ and Nestin+ Glioma Stem-Like Cells Reside Around CD31+ Arterioles in Niches that Express SDF-1α, CXCR4, Osteopontin and Cathepsin K. J Histochem Cytochem 2015; 63:481-93. [DOI: 10.1369/0022155415581689] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/16/2015] [Indexed: 11/22/2022] Open
Abstract
Poor survival of high-grade glioma is at least partly caused by glioma stem-like cells (GSLCs) that are resistant to therapy. GSLCs reside in niches in close vicinity of endothelium. The aim of the present study was to characterize proteins that may be functional in the GSLC niche by performing immunohistochemistry on serial cryostat sections of human high-grade glioma samples. We have found nine niches in five out of five high-grade glioma samples that were all surrounding arterioles with CD31+ endothelial cells and containing cellular structures that were CD133+ and nestin+. All nine niches expressed stromal-derived factor-1α (SDF-1α), its receptor C-X-C chemokine receptor type 4 (CXCR4), osteopontin and cathepsin K. SDF-1α plays a role in homing of CXCR4+ stem cells and leukocytes, whereas osteopontin and cathepsin K promote migration of cancer cells and leukocytes. Leukocyte-related markers, such as CD68, macrophage matrix metalloprotease-9, CD177 and neutrophil elastase were often but not always detected in the niches. We suggest that SDF-1α is involved in homing of CXCR4+ GSLCs and leukocytes and that cathepsin K and osteopontin are involved in the migration of GSLCs out of the niches.
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Affiliation(s)
- Vashendriya V. V. Hira
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Kimberley J. Ploegmakers
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Frederieke Grevers
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Urška Verbovšek
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Carlos Silvestre-Roig
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Eleonora Aronica
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Wikky Tigchelaar
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Tamara Lah Turnšek
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Remco J. Molenaar
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
| | - Cornelis J. F. Van Noorden
- Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands (VVVH, KJP, FG, WT, RJM, CJFVN)
- Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia (UV, TLT)
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands (CSR, EA)
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia (TLT)
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