Bruil Danique E, David Szabolcs, Nagtegaal Steven H J, de Sonnaville Sophia F A M, Verhoeff Joost J C
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Neurooncol Adv. 2022 Jan 13;4(1):vdab193. doi: 10.1093/noajnl/vdab193. eCollection 2022 Jan-Dec.
Neural stem cells in the subventricular zone (SVZ) and subgranular zone (SGZ) are hypothesized to support growth of glioma. Therefore, irradiation of the SVZ and SGZ might reduce tumor growth and might improve overall survival (OS). However, it may also inhibit the repair capacity of brain tissue. The aim of this retrospective cohort study is to assess the impact of SVZ and SGZ radiotherapy doses on OS of patients with high-grade (HGG) or low-grade (LGG) glioma.
We included 273 glioma patients who received radiotherapy. We created an SVZ atlas, shared openly with this work, while SGZ labels were taken from the CoBrA atlas. Next, SVZ and SGZ regions were automatically delineated on T1 MR images. Dose and OS correlations were investigated with Cox regression and Kaplan-Meier analysis.
Cox regression analyses showed significant hazard ratios for SVZ dose (univariate: 1.029/Gy, ; multivariate: 1.103/Gy, ) and SGZ dose (univariate: 1.023/Gy, ; multivariate: 1.055/Gy, ) in HGG patients. Kaplan-Meier analysis showed significant correlations between OS and high-/low-dose groups for HGG patients (SVZ: respectively 10.7 months (>30.33 Gy) vs 14.0 months (<30.33 Gy) median OS, ; SGZ: respectively 10.7 months (>29.11 Gy) vs 15.5 months (<29.11 Gy) median OS, ). No correlations between dose and OS were found for LGG patients.
Irradiation doses on neurogenic areas correlate negatively with OS in patients with HGG. Whether sparing of the SVZ and SGZ during radiotherapy improves OS, should be subject of prospective studies.
脑室下区（SVZ）和颗粒下区（SGZ）的神经干细胞被认为支持胶质瘤的生长。因此，对SVZ和SGZ进行照射可能会减少肿瘤生长并可能改善总生存期（OS）。然而，这也可能会抑制脑组织的修复能力。这项回顾性队列研究的目的是评估SVZ和SGZ放疗剂量对高级别（HGG）或低级别（LGG）胶质瘤患者OS的影响。
我们纳入了273例接受放疗的胶质瘤患者。我们创建了一个SVZ图谱，并在这项研究中公开分享，而SGZ标签取自CoBrA图谱。接下来，在T1 MR图像上自动勾勒出SVZ和SGZ区域。采用Cox回归和Kaplan-Meier分析研究剂量与OS的相关性。
Cox回归分析显示，HGG患者的SVZ剂量（单因素：1.029/Gy，；多因素：1.103/Gy，）和SGZ剂量（单因素：1.023/Gy，；多因素：1.055/Gy，）具有显著的风险比。Kaplan-Meier分析显示，HGG患者的OS与高/低剂量组之间存在显著相关性（SVZ：中位OS分别为10.7个月（>30.33 Gy）对14.0个月（<30.33 Gy），；SGZ：中位OS分别为10.7个月（>29.11 Gy）对15.5个月（<29.11 Gy），）。未发现LGG患者的剂量与OS之间存在相关性。
HGG患者神经源性区域的照射剂量与OS呈负相关。放疗期间对SVZ和SGZ进行保护是否能改善OS，应成为前瞻性研究的课题。
