Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) and Tata Memorial Hospital, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.
J Neurooncol. 2012 Aug;109(1):195-203. doi: 10.1007/s11060-012-0887-3. Epub 2012 May 4.
Glioblastoma progenitor or stem cells residing in the stem-cell niche in the subventricular zones (SVZ) can initiate or promote tumorigenesis. They can also migrate throughout the brain, resulting in disease progression. Irradiation of potential cancer stem-cell niche in the SVZ may influence survival. To analyze radiotherapy dose-volume parameters to the SVZ that correlate with survival in adequately treated patients with newly diagnosed glioblastoma, 40 adults with histopathologically proven supratentorial glioblastoma with available baseline imaging treated with postoperative conventionally fractionated focal conformal radiotherapy plus chemotherapy, available radiotherapy planning dataset, and documented event of progression or death or minimum 6-month follow-up were included in this retrospective study. Dose-volume parameters to the SVZ were extracted from treatment planning system and analyzed in relation to survival outcomes. Mean ipsilateral and contralateral SVZ volumes were 5.6 and 6.4 cc, respectively. With median follow-up of 15 months (interquartile range 12-18 months), median [95 % confidence interval (CI)] progression-free survival (PFS) and overall survival (OAS) was 11 months (95 % CI 8.9-13.0 months) and 17 months (95 % CI 11.6-22.4 months), respectively. Older age (>50 years), poor recursive partitioning analysis (RPA) class, and higher than median of mean contralateral SVZ dose were associated with significantly worse PFS and OAS. Multivariate analysis identified RPA class, Karnofsky performance status, and mean ipsilateral SVZ dose as independent predictors of survival. Increasing mean dose to the ipsilateral SVZ was associated with significantly improved OAS. Irradiation of potential cancer stem-cell niche influences survival outcomes in patients with newly diagnosed glioblastoma.
室管膜下区（SVZ）中的神经干细胞或祖细胞可引发或促进肿瘤发生。它们还可以迁移到整个大脑，导致疾病进展。对 SVZ 中潜在的癌症干细胞龛进行放疗可能会影响生存。为了分析与新诊断的胶质母细胞瘤患者生存相关的 SVZ 的放疗剂量-体积参数，本回顾性研究纳入了 40 名经组织病理学证实的幕上胶质母细胞瘤成人患者，这些患者术后接受常规分割适形聚焦放疗联合化疗，有基线影像学检查资料，有放疗计划数据集，且有进展或死亡或至少 6 个月随访的记录事件。从治疗计划系统中提取 SVZ 的剂量-体积参数，并分析其与生存结果的关系。同侧和对侧 SVZ 的平均体积分别为 5.6 和 6.4cc。中位随访时间为 15 个月（四分位间距 12-18 个月），中位[95%置信区间（CI）]无进展生存期（PFS）和总生存期（OAS）分别为 11 个月（95%CI 8.9-13.0 个月）和 17 个月（95%CI 11.6-22.4 个月）。年龄较大（>50 岁）、递归分区分析（RPA）分级较差和对侧 SVZ 平均剂量高于中位数与 PFS 和 OAS 显著更差相关。多变量分析确定 RPA 分级、卡氏功能状态和同侧 SVZ 平均剂量是生存的独立预测因素。同侧 SVZ 平均剂量的增加与 OAS 的显著改善相关。对新诊断的胶质母细胞瘤患者，潜在的癌症干细胞龛的照射会影响生存结果。
