Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.
Neurosurgery. 2020 Jul 1;87(1):E31-E40. doi: 10.1093/neuros/nyaa107.
In treating glioblastoma, irradiation of the neural progenitor cell (NPC) niches is controversial. Lower hippocampal doses may limit neurocognitive toxicity, but higher doses to the subventricular zones (SVZ) may improve survival.
To prospectively evaluate the impact of limiting radiation dose to the NPC niches on tumor progression, survival, and cognition in patients with glioblastoma.
Patients with glioblastoma received resection followed by standard chemoradiation. Radiation dose to the NPC niches, including the bilateral hippocampi and SVZ, was minimized without compromising tumor coverage. The primary outcome was tumor progression in the spared NPC niches. Follow-up magnetic resonance imaging was obtained bimonthly. Neurocognitive testing was performed before treatment and at 6- and 12-mo follow-up. Cox regression evaluated predictors of overall and progression-free survival. Linear regression evaluated predictors of neurocognitive decline.
A total of 30 patients enrolled prospectively. The median age was 58 yr. Median mean doses to the hippocampi and SVZ were 49.1 and 41.8 gray (Gy) ipsilaterally, and 16.5 and 19.9 Gy contralaterally. Median times to death and tumor progression were 16.0 and 7.6 mo, and were not significantly different compared to a matched historical control. No patients experienced tumor progression in the spared NPC-containing regions. Overall survival was associated with neurocognitive function (P ≤ .03) but not dose to the NPC niches. Higher doses to the hippocampi and SVZ predicted greater decline in verbal memory (P ≤ .01).
In treating glioblastoma, limiting dose to the NPC niches may reduce cognitive toxicity while maintaining clinical outcomes. Further studies are needed to confirm these results.
在治疗胶质母细胞瘤时，照射神经祖细胞（NPC）巢区存在争议。降低海马剂量可能会限制神经认知毒性，但增加脑室下区（SVZ）的剂量可能会提高生存率。
前瞻性评估限制 NPC 巢区放射剂量对胶质母细胞瘤患者肿瘤进展、生存和认知的影响。
胶质母细胞瘤患者接受手术切除后行标准放化疗。NPC 巢区（包括双侧海马区和 SVZ）的放射剂量最小化，但不影响肿瘤覆盖范围。主要结局是 NPC 巢区未照射肿瘤的进展。每隔两个月进行随访磁共振成像检查。在治疗前、治疗后 6 个月和 12 个月进行神经认知测试。Cox 回归分析评估总生存和无进展生存的预测因素。线性回归分析评估神经认知下降的预测因素。
共前瞻性纳入 30 例患者。中位年龄为 58 岁。双侧海马区和 SVZ 的中位平均剂量分别为 49.1 和 41.8 Gy 同侧，16.5 和 19.9 Gy 对侧。中位死亡时间和肿瘤进展时间分别为 16.0 个月和 7.6 个月，与匹配的历史对照组相比无显著差异。没有患者在 NPC 包含的区域出现肿瘤进展。总生存与神经认知功能相关（P ≤ 0.03），与 NPC 巢区的剂量无关。海马区和 SVZ 的剂量越高，言语记忆下降越明显（P ≤ 0.01）。
在治疗胶质母细胞瘤时，限制 NPC 巢区的剂量可能会降低认知毒性，同时保持临床结局。需要进一步的研究来证实这些结果。
