Glioblastoma recurrence patterns near neural stem cell regions

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• 作者：Linda Chen^a ; Kaisorn L. Chaichana^b ; Lawrence Kleinberg^a ; Xiaobu Ye^c ; Alfredo Quinones-Hinojosa^b ; ^c ; ^{aquinon2@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Kristin Redmond^a ; ^{kjanson3@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Glioblastoma ; Subventricular zone ; Recurrence
• 刊名：Radiotherapy and Oncology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：116
• 期：2
• 页码：294-300
• 全文大小：754 K

文摘

Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood–brain barrier breakdown.

Methods

102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern.

Results

49 of 102 (48.0%, 95% CI: 0.386–0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565–0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760–0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386–0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195–0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212–0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655–0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95% CI: 1.18–8.62).

Conclusions

GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.