Vascular Distribution of Glioblastoma Multiforme at Diagnosis

Abstract

<jats:p> Treatment of high-grade gliomas with selective intra-arterial (IA) administration of chemotherapies has been proposed, and utilized as a therapeutic modality. This approach offers the conceptual benefit of providing maximal delivery of the agent to the tumor bed, while potentially reducing systemic exposure to the agent. This retrospective study was designed to determine the vascular distribution of glioblastoma multiforme (GBM) at the time of diagnosis in an effort to determine what proportion of patients would likely be candidates for this approach. The preoperative MRI scans of 50 patients with GBM were analyzed and compared to published normative data of intracranial vascular distribution. Vascular distribution was determined by analyzing post-gadolinium axial and coronal T1 images, axial T2 images, and axial T2 images with an additional 1 cm margin (T2 + 1 cm) added in all dimensions. T1 analysis demonstrated 60% of tumors in a single vascular distribution. T2 analysis of these tumors reduced that number to 34%. When the T2 + 1 cm margin was utilized, only 6% of tumors were in a single vascular distribution. 66% of tumors were limited to the anterior circulation on T1 imaging but only 34% on T2 + 1 cm imaging. 30% of tumors were also within the distribution of the anterior choroidal artery. These findings suggest that the use of selective IA administration of agents is necessarily limited to a fraction of presenting patients or will require administration via multiple cerebral arteries. </jats:p>

Beyond the Blood:Brain Barrier: The Importance of Central Nervous System (CNS) Pharmacokinetics for the Treatment of CNS Tumors, Including Diffuse Intrinsic Pontine Glioma

“…With the development of microcatheters, IA delivery with distal cannulation of super-selective arteries is now possible; although this may reduce neurologic complications, this comes at the cost of increased streaming effects ( 48 ). In addition, drug delivery is limited to a more precise region, which may not reach the invasive malignant cells at the tumor edge, and only a small percentage (6%) of patients with glioblastoma have a single vessel identified as supplying the tumor ( 51 ). Because most adult malignant gliomas are supratentorial, intracarotid arterial administration techniques can be used.…”

Novel therapeutic delivery approaches in development for pediatric gliomas

“…This has advantages over carotid or vertebral artery infusions because the drug is delivered specifically to the tumor area, avoiding normal tissue and potentially reducing neurotoxicity [27]. However, a recent study reported that only 6% of patients with glioblastoma have a single vessel supplying the tumor [28]. The selective intra-arterial technique has been performed in concert with selective infusion of mannitol; although permeability of the BBB is increased, disruption is nonspecific.…”

Uncovering a Distinct Gene Signature in Endothelial Cells Associated With Contrast Enhancement in Glioblastoma

“…Tumor neoangiogenesis can be determined by the cerebral blood volume (CBV), which can be calculated from dynamic susceptibility contrast MRI (DSC-MRI) (6,7). The leakiness of GBM vasculature can be detected by the conventional contrast-enhanced MRI following intravenous administration of gadolinium-based contrast agents (8). As a result of diffusion of contrast molecules out of vessels and accumulation within extracellular space in tumors, contrastenhancing hyper-intense regions on T1-weighted (T1W) sequences are presented in nearly all GBM (9).…”