Khalifa J, Tensaouti F, Lusque A, Plas B, Lotterie J-A, Benouaich-Amiel A, Uro-Coste E, Lubrano V, Cohen-Jonathan Moyal E
Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopôle/Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France.
Toulouse NeuroImaging Center, ToNIC, Université de Toulouse, INSERM, Université Paul Sabatier, Toulouse, France.
Radiat Oncol. 2017 Apr 20;12(1):67. doi: 10.1186/s13014-017-0791-2.
We aimed to identify subventricular zone (SVZ)-related prognostic factors of survival and patterns of recurrence among patients with glioblastoma.
Forty-three patients with primary diagnosed glioblastoma treated in our Cancer Center between 2006 and 2010 were identified. All patients received surgical resection, followed by temozolomide-based chemoradiation. Ipsilateral (iSVZ), contralateral (cSVZ) and bilateral (bSVZ) SVZs were retrospectively segmented and radiation dose-volume histograms were generated. Multivariate analysis using the Cox proportional hazards model was assessed to examine the relationship between prognostic factors and time to progression (TTP) or overall survival (OS).
Median age was 59 years (range: 25-85). Median follow-up, OS and TTP were 22.7 months (range 7.5-69.7 months), 22.7 months (95% CI 14.5-26.2 months) and 6.4 months (95% CI 4.4-9.3 months), respectively. On univariate analysis, initial contact to SVZ was a poor prognostic factor for OS (18.7 vs 41.7 months, p = 0.014) and TTP (4.6 vs 12.9 months, p = 0.002). Patients whose bSVZ volume receiving at least 20 Gy (V20Gy) was greater than 84% had a significantly improved TTP (17.7 months vs 5.2 months, p = 0.017). This radiation dose coverage was compatible with an hippocampal sparing. On multivariate analysis, initial contact to SVZ and V20 Gy to bSVZ lesser than 84% remained poor prognostic factors for TTP (HR = 3.07, p = 0.012 and HR = 2.67, p = 0.047, respectively).
Our results suggest that contact to SVZ, as well as insufficient bSVZ radiation dose coverage (V20Gy <84%), might be independent poor prognostic factors for TTP. Therefore, targeting SVZ could be of crucial interest for optimizing glioblastoma treatment.
我们旨在确定胶质母细胞瘤患者脑室下区（SVZ）相关的生存预后因素及复发模式。
确定了2006年至2010年间在我们癌症中心接受治疗的43例初诊胶质母细胞瘤患者。所有患者均接受手术切除，随后进行基于替莫唑胺的放化疗。对同侧（iSVZ）、对侧（cSVZ）和双侧（bSVZ）的SVZ进行回顾性分割，并生成放射剂量-体积直方图。使用Cox比例风险模型进行多变量分析，以检验预后因素与进展时间（TTP）或总生存期（OS）之间的关系。
中位年龄为59岁（范围：25 - 85岁）。中位随访时间、OS和TTP分别为22.7个月（范围7.5 - 69.7个月）、22.7个月（95%CI 14.5 - 26.2个月）和6.4个月（95%CI 4.4 - 9.3个月）。单变量分析显示，初始接触SVZ是OS（18.7个月对41.7个月，p = 0.014）和TTP（4.6个月对12.9个月，p = 0.002）的不良预后因素。接受至少20 Gy（V20Gy）照射的bSVZ体积大于84%的患者TTP显著改善（17.7个月对5.2个月，p = 0.017）。这种放射剂量覆盖与海马体保留兼容。多变量分析显示，初始接触SVZ和bSVZ的V20 Gy小于84%仍然是TTP的不良预后因素（HR = 3.07，p = 0.012和HR = 2.67，p = 0.047）。
我们的结果表明，接触SVZ以及bSVZ放射剂量覆盖不足（V20Gy <84%）可能是TTP的独立不良预后因素。因此，针对SVZ可能对优化胶质母细胞瘤治疗至关重要。
