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      Longitudinal MRI evidence for decreased survival among periventricular glioblastoma

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          Abstract

          While the prognosis of patients with glioblastoma (GBM) remains poor despite recent therapeutic advances, variable survival times suggest wide variation in tumor biology and an opportunity for stratified intervention. We used volumetric analysis and morphometrics to measure the spatial relationship between subventricular zone (SVZ) proximity and survival in a cohort of 39 newly diagnosed GBM patients. We collected T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance images (MRI) at pre-operative, post-operative, pre-radiation therapy, and post-radiation therapy time points, measured tumor volumes and distances to the SVZ, and collected clinical data. Univariate and multivariate Cox regression showed that tumors involving the SVZ and tumor growth rate during radiation therapy were independent predictors of shorter progression-free and overall survival. These results suggest that GBMs in close proximity to the ependymal surface of the ventricles convey a worse prognosis-an observation that may be useful for stratifying treatment.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s11060-010-0477-1) contains supplementary material, which is available to authorized users.

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          Most cited references13

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          Response criteria for phase II studies of supratentorial malignant glioma.

          We suggest "new" response criteria for phase II studies of supratentorial malignant glioma and favor rigorous criteria similar to those in medical oncology, with important modifications. Four response categories are proposed: complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Response in this scheme is based on major changes in tumor size on the enhanced computed tomographic (CT) or magnetic resonance imaging (MRI) scan. Scan changes are interpreted in light of steroid use and neurologic findings. We advocate careful patient selection, emphasize pitfalls in the assessment of response, and suggest guidelines to minimize misinterpretations of response.
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            Neural stem cells and the origin of gliomas.

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              Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype.

              Neural stem cells with astrocyte-like characteristics exist in the human brain subventricular zone (SVZ), and these cells may give rise to glioblastoma multiforme (GBM). We therefore analyzed MRI features of GBMs in specific relation to the SVZ. We reviewed the preoperative and serial postoperative MR images of 53 patients with newly diagnosed GBM. The spatial relationship of the contrast-enhancing lesion (CEL) with the SVZ and cortex was determined preoperatively. Classification was as follows: group I, CEL contacting SVZ and infiltrating cortex; group II, CEL contacting SVZ but not involving cortex; group III, CEL not contacting SVZ but involving cortex; and group IV, CEL neither contacting SVZ nor infiltrating cortex. Patients with group I GBMs (n = 16) were most likely to have multifocal disease at diagnosis (9 patients, 56%, p = 0.001). In contrast, group IV GBMs (n = 14) were never multifocal. Group II (n = 14) and group III (n = 9) GBMs were multifocal in 11% and 29% of cases, respectively. Group I GBMs always had tumor recurrences noncontiguous with the initial lesion(s), while group IV GBM recurrences were always bordering the primary lesion. Group I GBMs may be most related to SVZ stem cells; these tumors were in intimate contact with the SVZ, were most likely to be multifocal at diagnosis, and recurred at great distances to the initial lesion(s). In contrast, group IV GBMs were always solitary lesions; these may arise from non-SVZ, white matter glial progenitors. Our MRI-based classification of GBMs may further our understanding of GBM histogenesis and help predict tumor recurrence pattern.
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                Author and article information

                Contributors
                +617-732-8358 , +617-264-5151 , gsyoung@partners.org
                +858-822-7524 , +858-822-7525 , skesari@ucsd.edu
                Journal
                J Neurooncol
                Journal of Neuro-Oncology
                Springer US (Boston )
                0167-594X
                1573-7373
                5 December 2010
                5 December 2010
                August 2011
                : 104
                : 1
                : 261-269
                Affiliations
                [1 ]Department of Radiology, Division of Neuroradiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
                [2 ]Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
                [3 ]Center for Neuro-Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115 USA
                [4 ]Department of Neurology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
                [5 ]Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
                [6 ]Department of Neurosciences, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Drive, MC 0819, La Jolla, CA 92093-0819 USA
                Article
                477
                10.1007/s11060-010-0477-1
                3151407
                21132516
                da684528-1d99-446e-9657-938658b79bf8
                © The Author(s) 2010
                History
                : 9 September 2010
                : 17 November 2010
                Categories
                Clinical Study - Patient Study
                Custom metadata
                © Springer Science+Business Media, LLC. 2011

                Oncology & Radiotherapy
                stem cell,mri,svz,outcome,glioblastoma
                Oncology & Radiotherapy
                stem cell, mri, svz, outcome, glioblastoma

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