Tumor-associated edema in brain cancer patients: pathogenesis and management

Roth, Patrick; Regli, Luca; Tonder, Michaela

doi:10.1586/14737140.2013.852473

Cited by 43 publications

(42 citation statements)

References 71 publications

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“…Since the survival time for GBM patients is appallingly short, this possibility warrants in‐depth investigation in a clinical setting. Since long‐term exposure to GCs has adverse side effects, including hyperglycemia, osteoporosis and myopathy, alternative treatments to reduce the dependency on GCs are already under consideration. For example, anti‐angiogenic drugs such as the anti‐VEGF monoclonal antibody bevacizumab, which aims to reduce the aberrant and hyperpermeable vasculature of tumors, can be used to reduce brain‐associated edema .…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoids promote a glioma stem cell‐like phenotype and resistance to chemotherapy in human glioblastoma primary cells: Biological and prognostic significance

Kostopoulou

Mohammad

Bártek

et al. 2017

Intl Journal of Cancer

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Glioma stem cells (GSCs) are glioblastoma (GBM) cells that are resistant to therapy and can give rise to recurrent tumors. The identification of patient-related factors that support GSCs is thus necessary to design effective therapies for GBM patients. Glucocorticoids (GCs) are used to treat GBM-associated edema. However, glucocorticoids participate in the physiological response to psychosocial stress, which has been linked to poor cancer prognosis. This raises concern that glucocorticoids affect the tumor and GSCs. Here, we treated primary human GBM cells with dexamethasone and evaluated GC-driven changes in cell morphology, proliferation, migration, gene expression, secretory activity and growth as neurospheres. Dexamethasone treatment of GBM cells appeared to promote the development of a GSC-like phenotype and conferred resistance to physiological stress and chemotherapy. We also analyzed a potential correlation between GC treatment and tumor recurrence after surgical excision in a population-based consecutive cohort of 48 GBM patients, adjusted for differences in known prognostic factors concerning baseline and treatment characteristics. In this cohort, we found a negative correlation between GC intake and progression-free survival, regardless of the MGMT methylation status. In conclusion, our findings raise concern that treatment of GBM with GCs may compromise the efficacy of chemotherapy and may support a GSC population, which could contribute to tumor recurrence and the poor prognosis of the disease.

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Section: Discussionmentioning

confidence: 99%

Glucocorticoids promote a glioma stem cell‐like phenotype and resistance to chemotherapy in human glioblastoma primary cells: Biological and prognostic significance

Kostopoulou

Mohammad

Bártek

et al. 2017

Intl Journal of Cancer

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“…Increased blood-brain barrier permeability is a key factor in the development of PTBE. 2 Radiotherapy, as an irreplaceable part in the treatment of BM, induces blood vessel damage and ultimately aggravates VBE. The secretion of VEGF by tumor cells plays a critical role in VBE and VEGF antibody bevacizumab gained certain anti-edema effect.…”

Section: Introductionmentioning

confidence: 99%

“…The secretion of VEGF by tumor cells plays a critical role in VBE and VEGF antibody bevacizumab gained certain anti-edema effect. 2 In view of high cost of bevacizumab, other novel VEGF inhibitors should be urgently explored to solve this difficult situation.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment using apatinib in intractable brain edema: A case report and literatures review

Song

Liu

2018

Cancer Biology & Therapy

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The treatment of intractable vasogenic brain edema (VBE) caused by tumor and irradiation is challenging. Traditional intervention strategy includes dehydration and glucocorticoids accompanied by obvious side effects and minor effects after long-term use. Novel treatment needs to be found urgently. Recently, vascular endothelial growth factor (VEGF)/VEGFR pathway has been revealed to be essential in VBE. Therefore, tyrosine kinase inhibitor (TKI) targeting VEGFR which blocks (VEGF)/VEGFR signal might be effective. However, such reports have seldom been described. Herein, we documented a heavily-treated breast cancer patient experienced progressive aphasia, limb activity disorder and intermittent convulsion 10 months after radiotherapy of brain metastasis (BM). Cranial MRI demonstrated large peritumoral brain edema (PTBE). High dose of steriods and dehydration had no improvement. Apatinib with a dose of 250mg daily was initiated and all her discomforts disappeared after 10 days of use. The brain MRI of taking apatinib 5 weeks demonstrated remarkable shrinkage of edema. Our case indicates that apatinib, a potent small-molecular TKI targeted VEGFR2 is promising for intractable VBE for satisfactory efficacy and safety. This case is of great value in its rarity and because it provides new insight into PTBE management in clinical practice.

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“…PTO usually induces compression of the surrounding brain tissues leading to clinical manifestation and dynamically changes along with the evolution of the disease. 1 In addition, the extent of PTO has been demonstrated to be associated with malignant brain tumour growth patterns 2 and also with patient survival. 2,3 However, quantitative approaches for describing the radiological feature of PTO has not been well studied.…”

Section: Introductionmentioning

confidence: 99%

Segmentation of peritumoral oedema offers a valuable radiological feature of cerebral metastasis

Zhou¹,

Yang²,

Yao³

et al. 2016

BJR

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Chengcheng Zhou and Zixiao Yang contributed equally to this study.Objective: Peritumoral oedema (PTO) is commonly observed on MRI in malignant brain tumours including brain metastasis (bMET) and glioblastoma multiforme (GBM). This study aimed to differentiate bMET from GBM by comparing the volume ratio of PTO to tumour lesion (R vol ).Methods: 56 patients with solitary bMET or GBM were enrolled, and MRI was analyzed by a semi-automatic methodology based on MATLAB (Mathworks, Natick, MA). The PTO volume (V oedema ) was segmented for quantification using T 2 fluid-attenuated inversion-recovery images, while the tumour volume was quantified with enhanced T 1 images. The quantitative volume of the tumour, PTO and the ratio of PTO to tumour were interpreted using SPSS® (IBM Corp., New York, NY; formerly SPSS Inc., Chicago, IL) by considering different locations and pathologies. Results: The tumour volumes of supratentorial GBM, supratentorial bMET (supra-bMET) and infratentorial bMET were 32.22 6 21.9, 18.45 6 17.28 and 11.40 6 5.63 ml, respectively. The corresponding V oedema were 44.08 6 25.84, 73.20 6 40.35 and 23.74 6 7.78 ml, respectively. The V oedema difference between supratentorial and infratentorial lesions is significant (p-value 5 0.002). SuprabMET has a smaller tumour volume (p-value 5 0.032), but a larger PTO (p-value 5 0.007). The ratio of V oedema to the tumour volume in bMET is statistically higher than that in GBM (p-value 5 0.015). The cut-off ratio for identifying bMET from GBM is 3.9, with a specificity and sensitivity of 90.0% and 68.8%, respectively. Conclusion: Segmentation is an efficient method to quantify irregular PTO. bMET possesses more extensive oedema with smaller tumour volume than does GBM. The R vol is a valuable index to distinguish bMET from GBM. Advances in knowledge: This study presents a new method for the quantitation of PTO to differentiate bMET from GBM.

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Tumor-associated edema in brain cancer patients: pathogenesis and management

Cited by 43 publications

References 71 publications

Glucocorticoids promote a glioma stem cell‐like phenotype and resistance to chemotherapy in human glioblastoma primary cells: Biological and prognostic significance

Glucocorticoids promote a glioma stem cell‐like phenotype and resistance to chemotherapy in human glioblastoma primary cells: Biological and prognostic significance

Successful treatment using apatinib in intractable brain edema: A case report and literatures review

Segmentation of peritumoral oedema offers a valuable radiological feature of cerebral metastasis

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