Glioblastoma recurrence patterns near neural stem cell regions

Linda Chen, Kaisorn L. Chaichana, Lawrence R Kleinberg, Xiaobu Ye, Alfredo Quinones-Hinojosa, Kristin A Redmond

Research output: Contribution to journalArticle

Abstract

Purpose Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood-brain barrier breakdown. Methods 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. Results 49 of 102 (48.0%, 95% CI: 0.386-0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565-0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760-0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386-0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195-0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212-0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655-0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95% CI: 1.18-8.62). Conclusions GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.

Original languageEnglish (US)
Pages (from-to)294-300
Number of pages7
JournalRadiotherapy and Oncology
Volume116
Issue number2
DOIs
StatePublished - 2015

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Neural Stem Cells
Glioblastoma
Recurrence
Neoplasms
temozolomide
Radiation
Neoplastic Stem Cells
Lateral Ventricles
Chi-Square Distribution
Blood-Brain Barrier
Odds Ratio

Keywords

  • Glioblastoma
  • Recurrence
  • Subventricular zone

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Glioblastoma recurrence patterns near neural stem cell regions. / Chen, Linda; Chaichana, Kaisorn L.; Kleinberg, Lawrence R; Ye, Xiaobu; Quinones-Hinojosa, Alfredo; Redmond, Kristin A.

In: Radiotherapy and Oncology, Vol. 116, No. 2, 2015, p. 294-300.

Research output: Contribution to journalArticle

Chen, Linda ; Chaichana, Kaisorn L. ; Kleinberg, Lawrence R ; Ye, Xiaobu ; Quinones-Hinojosa, Alfredo ; Redmond, Kristin A. / Glioblastoma recurrence patterns near neural stem cell regions. In: Radiotherapy and Oncology. 2015 ; Vol. 116, No. 2. pp. 294-300.
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title = "Glioblastoma recurrence patterns near neural stem cell regions",
abstract = "Purpose Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood-brain barrier breakdown. Methods 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. Results 49 of 102 (48.0{\%}, 95{\%} CI: 0.386-0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100{\%}) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8{\%}, 95{\%} CI: 0.565-0.804) recurred contacting NRs. In total, 86/102 (84.3{\%}, 95{\%} CI: 0.760-0.901) recurrent GBM contacted NRs compared with 49/102 (48{\%}, 95{\%} CI: 0.386-0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1{\%}, 95{\%} CI: 0.195-0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6{\%}, 95{\%} CI: 0.212-0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2{\%}, 95{\%} CI: 0.0655-0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95{\%} CI: 1.18-8.62). Conclusions GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.",
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T1 - Glioblastoma recurrence patterns near neural stem cell regions

AU - Chen, Linda

AU - Chaichana, Kaisorn L.

AU - Kleinberg, Lawrence R

AU - Ye, Xiaobu

AU - Quinones-Hinojosa, Alfredo

AU - Redmond, Kristin A

PY - 2015

Y1 - 2015

N2 - Purpose Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood-brain barrier breakdown. Methods 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. Results 49 of 102 (48.0%, 95% CI: 0.386-0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565-0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760-0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386-0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195-0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212-0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655-0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95% CI: 1.18-8.62). Conclusions GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.

AB - Purpose Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood-brain barrier breakdown. Methods 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. Results 49 of 102 (48.0%, 95% CI: 0.386-0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565-0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760-0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386-0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195-0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212-0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655-0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95% CI: 1.18-8.62). Conclusions GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.

KW - Glioblastoma

KW - Recurrence

KW - Subventricular zone

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