Limits...
Perioperative cerebral ischemia promote infiltrative recurrence in glioblastoma.

Thiepold AL, Luger S, Wagner M, Filmann N, Ronellenfitsch MW, Harter PN, Braczynski AK, Dützmann S, Hattingen E, Steinbach JP, Senft C, Rieger J, Bähr O - Oncotarget (2015)

Bottom Line: Both cohorts were analyzed for patterns of progression by a blinded neuroradiologist.The results of the control cohort matched well with historical data.The change in patterns of progression was not associated with a difference in survival.

View Article: PubMed Central - PubMed

Affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany.

ABSTRACT

Background: Hypoxia is a key driver for infiltrative growth in experimental gliomas. It has remained elusive whether tumor hypoxia in glioblastoma patients contributes to distant or diffuse recurrences. We therefore investigated the influence of perioperative cerebral ischemia on patterns of progression in glioblastoma patients.

Methods: We retrospectively screened MRI scans of 245 patients with newly diagnosed glioblastoma undergoing resection for perioperative ischemia near the resection cavity. 46 showed relevant ischemia nearby the resection cavity. A control cohort without perioperative ischemia was generated by a 1:1 matching using an algorithm based on gender, age and adjuvant treatment. Both cohorts were analyzed for patterns of progression by a blinded neuroradiologist.

Results: The percentage of diffuse or distant recurrences at first relapse was significantly higher in the cohort with perioperative ischemia (61.1%) compared to the control cohort (19.4%). The results of the control cohort matched well with historical data. The change in patterns of progression was not associated with a difference in survival.

Conclusions: This study reveals an unrecognized association of perioperative cerebral ischemia with distant or diffuse recurrence in glioblastoma. It is the first clinical study supporting the concept that hypoxia is a key driver of infiltrative tumor growth in glioblastoma patients.

No MeSH data available.


Related in: MedlinePlus

Perioperative ischemiaRepresentative pre- and postoperative (< 72h after surgery) MRI scans from a patient with perioperative ischemia ARE shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4546485&req=5

Figure 2: Perioperative ischemiaRepresentative pre- and postoperative (< 72h after surgery) MRI scans from a patient with perioperative ischemia ARE shown.

Mentions: Postoperative MRI was performed within 72 h following tumor resection on a 3 Tesla scanner (Siemens Medical AG). The protocol included T1-weighted (T1-w) sequences before and after intravenous administration of Gadolinium-containing contrast agent, T2-weighted sequences and DWI-sequences with calculated ADC-maps. To exclude postoperative hemorrhage as a cause of restricted diffusion T2*-weighted sequences were applied. DWI-Volume of each slice was approximated by multiplying the area of the ischemic lesions with the slice thickness including the gap between the slices. The volume of the whole ischemic lesion was calculated by adding the volumes of each slice. Only patients showing larger areas of relevant ischemia with high DWI-signal and corresponding low ADC-values nearby the resection cavity were enrolled (DWI-Volume > 3 cm³). MRI of a representative patient is shown in Figure 2. A small rim of diffusion restriction around the surgical cavity as often seen on postoperative MRI was not regarded as relevant ischemia. During follow-up the areas of restricted diffusion were assessed with particular attention. As expected, the course of these areas was typical for cerebral ischemia with temporary contrast enhancement and finally ischemic gliosis.


Perioperative cerebral ischemia promote infiltrative recurrence in glioblastoma.

Thiepold AL, Luger S, Wagner M, Filmann N, Ronellenfitsch MW, Harter PN, Braczynski AK, Dützmann S, Hattingen E, Steinbach JP, Senft C, Rieger J, Bähr O - Oncotarget (2015)

Perioperative ischemiaRepresentative pre- and postoperative (< 72h after surgery) MRI scans from a patient with perioperative ischemia ARE shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4546485&req=5

Figure 2: Perioperative ischemiaRepresentative pre- and postoperative (< 72h after surgery) MRI scans from a patient with perioperative ischemia ARE shown.
Mentions: Postoperative MRI was performed within 72 h following tumor resection on a 3 Tesla scanner (Siemens Medical AG). The protocol included T1-weighted (T1-w) sequences before and after intravenous administration of Gadolinium-containing contrast agent, T2-weighted sequences and DWI-sequences with calculated ADC-maps. To exclude postoperative hemorrhage as a cause of restricted diffusion T2*-weighted sequences were applied. DWI-Volume of each slice was approximated by multiplying the area of the ischemic lesions with the slice thickness including the gap between the slices. The volume of the whole ischemic lesion was calculated by adding the volumes of each slice. Only patients showing larger areas of relevant ischemia with high DWI-signal and corresponding low ADC-values nearby the resection cavity were enrolled (DWI-Volume > 3 cm³). MRI of a representative patient is shown in Figure 2. A small rim of diffusion restriction around the surgical cavity as often seen on postoperative MRI was not regarded as relevant ischemia. During follow-up the areas of restricted diffusion were assessed with particular attention. As expected, the course of these areas was typical for cerebral ischemia with temporary contrast enhancement and finally ischemic gliosis.

Bottom Line: Both cohorts were analyzed for patterns of progression by a blinded neuroradiologist.The results of the control cohort matched well with historical data.The change in patterns of progression was not associated with a difference in survival.

View Article: PubMed Central - PubMed

Affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt, Germany.

ABSTRACT

Background: Hypoxia is a key driver for infiltrative growth in experimental gliomas. It has remained elusive whether tumor hypoxia in glioblastoma patients contributes to distant or diffuse recurrences. We therefore investigated the influence of perioperative cerebral ischemia on patterns of progression in glioblastoma patients.

Methods: We retrospectively screened MRI scans of 245 patients with newly diagnosed glioblastoma undergoing resection for perioperative ischemia near the resection cavity. 46 showed relevant ischemia nearby the resection cavity. A control cohort without perioperative ischemia was generated by a 1:1 matching using an algorithm based on gender, age and adjuvant treatment. Both cohorts were analyzed for patterns of progression by a blinded neuroradiologist.

Results: The percentage of diffuse or distant recurrences at first relapse was significantly higher in the cohort with perioperative ischemia (61.1%) compared to the control cohort (19.4%). The results of the control cohort matched well with historical data. The change in patterns of progression was not associated with a difference in survival.

Conclusions: This study reveals an unrecognized association of perioperative cerebral ischemia with distant or diffuse recurrence in glioblastoma. It is the first clinical study supporting the concept that hypoxia is a key driver of infiltrative tumor growth in glioblastoma patients.

No MeSH data available.


Related in: MedlinePlus