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Journal of Neuro-Oncology

, Volume 138, Issue 3, pp 549–556 | Cite as

Location of subventricular zone recurrence and its radiation dose predicts survival in patients with glioblastoma

  • Brent D. Weinberg
  • Lauren Boreta
  • Steve Braunstein
  • Soonmee Cha
Clinical Study

Abstract

Glioblastomas are aggressive brain tumors that frequently recur in the subventricular zone (SVZ) despite maximal treatment. The purpose of this study was to evaluate imaging patterns of subventricular progression and impact of recurrent subventricular tumor involvement and radiation dose to patient outcome. Retrospective review of 50 patients diagnosed with glioblastoma and treated with surgery, radiation, and concurrent temozolomide from January 2012 to June 2013 was performed. Tumors were classified based on location, size, and cortical and subventricular zone involvement. Survival was compared based on recurrence type, distance from the initial enhancing tumor (local ≤ 2 cm, distant > 2 cm), and the radiation dose at the recurrence site. Progression of enhancing subventricular tumor was common at both local (58%) and distant (42%) sites. Median survival was better after local SVZ recurrence than distant SVZ recurrence (8.7 vs. 4.3 months, p = 0.04). Radiation doses at local SVZ recurrence sites recurrence averaged 57.0 ± 4.0 Gy compared to 44.7 ± 6.7 Gy at distant SVZ recurrence sites (p = 0.008). Distant subventricular progression at a site receiving ≤ 45 Gy predicted worse subsequent survival (p = 0.05). Glioblastomas frequently recurred in the subventricular zone, and patient survival was worse when enhancing tumor occurred at sites that received lower radiation doses. This recurrent disease may represent disease undertreated at the time of diagnosis, and further study is needed to determine if improved treatment strategies, such as including the subventricular zone in radiation fields, could improve clinical outcomes.

Keywords

Glioblastoma External beam radiotherapy Subventricular zone Magnetic resonance imaging 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived by the institutional research committee for this retrospective study.

References

  1. 1.
    Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG (1989) Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16:1405–1409CrossRefPubMedGoogle Scholar
  2. 2.
    Adeberg S, Konig L, Bostel T, Harrabi S, Welzel T, Debus J, Combs SE (2014) Glioblastoma recurrence patterns after radiation therapy with regard to the subventricular zone. Int J Radiat Oncol Biol Phys 90:886–893.  https://doi.org/10.1016/j.ijrobp.2014.07.027 CrossRefPubMedGoogle Scholar
  3. 3.
    Adeberg S, Bostel T, Konig L, Welzel T, Debus J, Combs SE (2014) A comparison of long-term survivors and short-term survivors with glioblastoma, subventricular zone involvement: a predictive factor for survival? Radiat Oncol 9:95.  https://doi.org/10.1186/1748-717X-9-95 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lim DA, Cha S, Mayo MC, Chen MH, Keles E, VandenBerg S, Berger MS (2007) Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro Oncol 9:424–429.  https://doi.org/10.1215/15228517-2007-023 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jafri NF, Clarke JL, Weinberg V, Barani IJ, Cha S (2013) Relationship of glioblastoma multiforme to the subventricular zone is associated with survival. Neuro Oncol 15:91–96.  https://doi.org/10.1093/neuonc/nos268 CrossRefPubMedGoogle Scholar
  6. 6.
    Sonoda Y, Saito R, Kanamori M, Kumabe T, Uenohara H, Tominaga T (2014) The association of subventricular zone involvement at recurrence with survival after repeat surgery in patients with recurrent glioblastoma. Neurol Med Chir (Tokyo) 54:302–309CrossRefGoogle Scholar
  7. 7.
    Capdevila C, Rodriguez Vazquez L, Marti J (2017) Glioblastoma multiforme and adult neurogenesis in the ventricular–subventricular zone: a review. J Cell Physiol 237:1596–1601.  https://doi.org/10.1002/jcp.25502 CrossRefGoogle Scholar
  8. 8.
    Smith AW, Mehta MP, Wernicke AG (2016) Neural stem cells, the subventricular zone and radiotherapy: implications for treating glioblastoma. J Neurooncol 128:207–216.  https://doi.org/10.1007/s11060-016-2123-z CrossRefPubMedGoogle Scholar
  9. 9.
    Gibbs IC, Haas-Kogan D, Terezakis S, Kavanagh BD (2013) The subventricular zone neural progenitor cell hypothesis in glioblastoma: epiphany, Trojan Horse, or Cheshire fact? Int J Radiat Oncol Biol Phys 86:606–608.  https://doi.org/10.1016/j.ijrobp.2013.03.002 CrossRefPubMedGoogle Scholar
  10. 10.
    Lee P, Eppinga W, Lagerwaard F, Cloughesy T, Slotman B, Nghiemphu PL, Wang PC, Kupelian P, Agazaryan N, Demarco J, Selch MT, Steinberg M, Kang JJ (2013) Evaluation of high ipsilateral subventricular zone radiation therapy dose in glioblastoma: a pooled analysis. Int J Radiat Oncol Biol Phys 86:609–615.  https://doi.org/10.1016/j.ijrobp.2013.01.009 CrossRefPubMedGoogle Scholar
  11. 11.
    Kusumawidjaja G, Gan PZ, Ong WS, Teyateeti A, Dankulchai P, Tan DY, Chua ET, Chua KL, Tham CK, Wong FY, Chua ML (2016) Dose-escalated intensity-modulated radiotherapy and irradiation of subventricular zones in relation to tumor control outcomes of patients with glioblastoma multiforme. Onco Targets Ther 9:1115–1122.  https://doi.org/10.2147/OTT.S96509 PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Gupta T, Nair V, Paul SN, Kannan S, Moiyadi A, Epari S, Jalali R (2012) Can irradiation of potential cancer stem-cell niche in the subventricular zone influence survival in patients with newly diagnosed glioblastoma? J Neurooncol 109:195–203.  https://doi.org/10.1007/s11060-012-0887-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Chen L, Guerrero-Cazares H, Ye X, Ford E, McNutt T, Kleinberg L, Lim M, Chaichana K, Quinones-Hinojosa A, Redmond K (2013) Increased subventricular zone radiation dose correlates with survival in glioblastoma patients after gross total resection. Int J Radiat Oncol Biol Phys 86:616–622.  https://doi.org/10.1016/j.ijrobp.2013.02.014 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Iuchi T, Hatano K, Kodama T, Sakaida T, Yokoi S, Kawasaki K, Hasegawa Y, Hara R (2014) Phase 2 trial of hypofractionated high-dose intensity modulated radiation therapy with concurrent and adjuvant temozolomide for newly diagnosed glioblastoma. Int J Radiat Oncol Biol Phys 88:793–800.  https://doi.org/10.1016/j.ijrobp.2013.12.011 CrossRefPubMedGoogle Scholar
  15. 15.
    Elicin O, Inac E, Uzel EK, Karacam S, Uzel OE (2014) Relationship between survival and increased radiation dose to subventricular zone in glioblastoma is controversial. J Neurooncol 118:413–419.  https://doi.org/10.1007/s11060-014-1424-3 CrossRefPubMedGoogle Scholar
  16. 16.
    Allhenn D, Boushehri MA, Lamprecht A (2012) Drug delivery strategies for the treatment of malignant gliomas. Int J Pharm 436:299–310.  https://doi.org/10.1016/j.ijpharm.2012.06.025 CrossRefPubMedGoogle Scholar
  17. 17.
    Therneau T (2015) A package for survival analysis in S, version 2.38. http://CRAN.R-project.org/package=survival
  18. 18.
    Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer-Verlag, New YorkCrossRefGoogle Scholar
  19. 19.
    R Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/
  20. 20.
    Liang TH, Kuo SH, Wang CW, Chen WY, Hsu CY, Lai SF, Tseng HM, You SL, Chen CM, Tseng WY (2016) Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion. Radiother Oncol 118:16–23.  https://doi.org/10.1016/j.radonc.2015.11.017 CrossRefPubMedGoogle Scholar
  21. 21.
    Kita M, Okawa T, Tanaka M, Ikeda M (1989) Radiotherapy of malignant glioma–prospective randomized clinical study of whole brain vs local irradiation. Gan No Rinsho 35:1289–1294PubMedGoogle Scholar
  22. 22.
    Shapiro WR, Green SB, Burger PC, Mahaley MS Jr, Selker RG, VanGilder JC, Robertson JT, Ransohoff J, Mealey J Jr, Strike TA et al (1989) Randomized trial of three chemotherapy regimens and two radiotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71:1–9.  https://doi.org/10.3171/jns.1989.71.1.0001 CrossRefPubMedGoogle Scholar
  23. 23.
    Wernicke AG, Smith AW, Taube S, Mehta MP (2016) Glioblastoma: radiation treatment margins, how small is large enough? Pract Radiat Oncol 6:298–305.  https://doi.org/10.1016/j.prro.2015.12.002 CrossRefPubMedGoogle Scholar
  24. 24.
    Liang HT, Chen WY, Lai SF, Su MY, You SL, Chen LH, Tseng HM, Chen CM, Kuo SH, Tseng WI (2017) The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas. Radiother Oncol 125:248–257.  https://doi.org/10.1016/j.radonc.2017.09.024 CrossRefPubMedGoogle Scholar
  25. 25.
    Glantz M, Kesari S, Recht L, Fleischhack G, Van Horn A (2009) Understanding the origins of gliomas and developing novel therapies: cerebrospinal fluid and subventricular zone interplay. Semin Oncol 36:S17-24.  https://doi.org/10.1053/j.seminoncol.2009.05.003 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Brent D. Weinberg
    • 1
  • Lauren Boreta
    • 2
  • Steve Braunstein
    • 2
  • Soonmee Cha
    • 3
  1. 1.Department of Radiology and Imaging SciencesEmory UniversityAtlantaUSA
  2. 2.Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA

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