Patterns of relapse in glioblastoma multiforme following concomitant chemoradiotherapy with temozolomide

Sherriff, Jenny; Tamangani, J; Senthil, Latha; Cruickshank, Garth; Spooner, D.; Jones, Bleddyn; Brookes, Cassandra; Sanghera, Paul

doi:10.1259/bjr.20120414

Cited by 116 publications

(79 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, the immediate development of contrast-enhancing lesion adjacent to the blue isotherm line is a grim reminder that microscopic GBM foci exist outside of the visible contrast-enhancing volume. 13,16 In this context, SLA should only be considered if performed in the context of an integrated regimen of chemotherapy, immunotherapy, targeted therapy, and/or RT.…”

Section: Discussionmentioning

confidence: 99%

Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite

Rennert¹,

Carroll²,

Ali³

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE Stereotactic laser ablation (SLA) is typically performed in the setting of intraoperative MRI or in a staged manner in which probe insertion is performed in the operating room and thermal ablation takes place in an MRI suite. METHODS The authors describe their experience, in which SLA for glioblastoma (GBM) treatment was performed entirely within a conventional MRI suite using the SmartFrame stereotactic device. RESULTS All 10 patients with GBM (2 with isocitrate dehydrogenase 1 mutation [mIDH1] and 8 with wild-type IDH1 [wtIDH1]) were followed for > 6 months. One of these patients underwent 2 independent SLAs approximately 12 months apart. Biopsies were performed prior to SLA for all patients. There were no perioperative morbidities, wound infections, or unplanned 30-day readmissions. The average time for a 3-trajectory SLA (n = 3) was 436 ± 102 minutes; for a 2-trajectory SLA (n = 4) was 321 ± 85 minutes; and for a single-trajectory SLA (n = 4) was 254 ± 28 minutes. No tumor recurrence occurred within the blue isotherm line ablation zone, although 2 patients experienced recurrence immediately adjacent to the blue isotherm ablation line. Overall survival for the patient cohort averaged 356 days, with the 2 patients who had mIDH1 GBMs exhibiting the longest survival (811 and 654 days). CONCLUSIONS Multitrajectory SLA for treatment of GBM can be safely performed using the SmartFrame stereotactic device in a conventional MRI suite.

show abstract

Section: Discussionmentioning

confidence: 99%

Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite

Rennert¹,

Carroll²,

Ali³

et al. 2016

FOC

View full text Add to dashboard Cite

show abstract

“…It is only achieved in 35-50 % of cases [5,6] because the presence of functional areas makes impossible to perform a resection with safe margins and no risk of neurological impairment [4]. Despite complete surgical resection, recurrence happens in almost all cases, mostly at the margin of the resection cavity in the peritumoral brain zone (PBZ) [7,8]. It is widely believed that tumor cell infiltration into the PBZ may promote recurrence [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Characterizing the peritumoral brain zone in glioblastoma: a multidisciplinary analysis

et al. 2015

View full text Add to dashboard Cite

Glioblastoma (GB) is the most frequent and aggressive type of primary brain tumor. Recurrences are mostly located at the margin of the resection cavity in the peritumoral brain zone (PBZ). Although it is widely believed that infiltrative tumor cells in this zone are responsible for GB recurrence, few studies have examined this zone. In this study, we analyzed PBZ left after surgery with a variety of techniques including radiology, histopathology, flow cytometry, genomic, transcriptomic, proteomic, and primary cell cultures. The resulting PBZ profiles were compared with those of the GB tumor zone and normal brain samples to identify characteristics specific to the PBZ. We found that tumor cell infiltration detected by standard histological analysis was present in almost one third of PBZ taken from an area that was considered normal both on standard MRI and by the neurosurgeon under an operating microscope. The panel of techniques used in this study show that the PBZ, similar to the tumor zone itself, is characterized by substantial inter-patient heterogeneity, which makes it difficult to identify representative markers. Nevertheless, we identified specific alterations in the PBZ such as the presence of selected tumor clones and stromal cells with tumorigenic and angiogenic properties. The study of GB-PBZ is a growing field of interest and this region needs to be characterized further. This will facilitate the development of new, targeted therapies for patients with GB and the development of approaches to refine the per-operative evaluation of the PBZ to optimize the surgical resection of the tumor.

show abstract

“…However, the majority of GBMs recur in close proximity to the initial tumor bed and modern radiation treatment fields have shifted to treatment of the gross tumor volume and a 1–2 cm margin that is thought to contain residual microscopic disease at high risk for local progression [3,4]. Despite inclusion of this additional volume at risk for recurrence, the majority of glioblastomas progress locally within radiation treatment fields [5], and attempts at dose escalation or hypofractionation have not improved outcomes or changed the patterns of recurrence [6,7]. …”

mentioning

confidence: 99%

Glioblastoma recurrence patterns near neural stem cell regions

Chen

Chaichana

Kleinberg

et al. 2015

Radiotherapy and Oncology

View full text Add to dashboard Cite

Purpose 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.

show abstract

Patterns of relapse in glioblastoma multiforme following concomitant chemoradiotherapy with temozolomide

Cited by 116 publications

References 24 publications

Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite

Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite

Characterizing the peritumoral brain zone in glioblastoma: a multidisciplinary analysis

Glioblastoma recurrence patterns near neural stem cell regions

Contact Info

Product

Resources

About