Gupta Kshama, Burns Terry C
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.
Front Oncol. 2018 Nov 8;8:503. doi: 10.3389/fonc.2018.00503. eCollection 2018.
Glioblastoma (GBM) is uniformly fatal with a median survival of just over 1 year, despite best available treatment including radiotherapy (RT). Impacts of prior brain RT on recurrent tumors are poorly understood, though increasing evidence suggests RT-induced changes in the brain microenvironment contribute to recurrent GBM aggressiveness. The tumor microenvironment impacts malignant cells directly and indirectly through stromal cells that support tumor growth. Changes in extracellular matrix (ECM), abnormal vasculature, hypoxia, and inflammation have been reported to promote tumor aggressiveness that could be exacerbated by prior RT. Prior radiation may have long-term impacts on microglia and brain-infiltrating monocytes, leading to lasting alterations in cytokine signaling and ECM. Tumor-promoting CNS injury responses are recapitulated in the tumor microenvironment and augmented following prior radiation, impacting cell phenotype, proliferation, and infiltration in the CNS. Since RT is vital to GBM management, but substantially alters the tumor microenvironment, we here review challenges, knowledge gaps, and therapeutic opportunities relevant to targeting pro-tumorigenic features of the GBM microenvironment. We suggest that insights from RT-induced changes in the tumor microenvironment may provide opportunities to target mechanisms, such as cellular senescence, that may promote GBM aggressiveness amplified in previously radiated microenvironment.
胶质母细胞瘤(GBM)即便采用包括放疗(RT)在内的最佳现有治疗方法,通常仍会致命,其平均生存期仅略超过1年。尽管越来越多的证据表明放疗引起的脑微环境变化会导致复发性GBM的侵袭性增加,但先前脑部放疗对复发性肿瘤的影响仍知之甚少。肿瘤微环境通过支持肿瘤生长的基质细胞直接和间接地影响恶性细胞。据报道,细胞外基质(ECM)的变化、异常血管生成、缺氧和炎症会促进肿瘤侵袭性,而先前的放疗可能会加剧这种情况。先前的辐射可能会对小胶质细胞和脑浸润单核细胞产生长期影响,导致细胞因子信号传导和ECM的持久改变。肿瘤促进性中枢神经系统损伤反应在肿瘤微环境中重现,并在先前放疗后增强,影响细胞表型、增殖和在中枢神经系统中的浸润。由于放疗对GBM的治疗至关重要,但会显著改变肿瘤微环境,因此我们在此回顾与靶向GBM微环境的促肿瘤特征相关的挑战、知识空白和治疗机会。我们认为,放疗引起的肿瘤微环境变化所带来的见解可能为靶向细胞衰老等机制提供机会,这些机制可能会促进在先前接受过放疗的微环境中增强的GBM侵袭性。