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1.
Neurosurgery ; 87(1): E31-E40, 2020 07 01.
Article in English | MEDLINE | ID: mdl-32497183

ABSTRACT

BACKGROUND: In treating glioblastoma, irradiation of the neural progenitor cell (NPC) niches is controversial. Lower hippocampal doses may limit neurocognitive toxicity, but higher doses to the subventricular zones (SVZ) may improve survival. OBJECTIVE: To prospectively evaluate the impact of limiting radiation dose to the NPC niches on tumor progression, survival, and cognition in patients with glioblastoma. METHODS: Patients with glioblastoma received resection followed by standard chemoradiation. Radiation dose to the NPC niches, including the bilateral hippocampi and SVZ, was minimized without compromising tumor coverage. The primary outcome was tumor progression in the spared NPC niches. Follow-up magnetic resonance imaging was obtained bimonthly. Neurocognitive testing was performed before treatment and at 6- and 12-mo follow-up. Cox regression evaluated predictors of overall and progression-free survival. Linear regression evaluated predictors of neurocognitive decline. RESULTS: A total of 30 patients enrolled prospectively. The median age was 58 yr. Median mean doses to the hippocampi and SVZ were 49.1 and 41.8 gray (Gy) ipsilaterally, and 16.5 and 19.9 Gy contralaterally. Median times to death and tumor progression were 16.0 and 7.6 mo, and were not significantly different compared to a matched historical control. No patients experienced tumor progression in the spared NPC-containing regions. Overall survival was associated with neurocognitive function (P ≤ .03) but not dose to the NPC niches. Higher doses to the hippocampi and SVZ predicted greater decline in verbal memory (P ≤ .01). CONCLUSION: In treating glioblastoma, limiting dose to the NPC niches may reduce cognitive toxicity while maintaining clinical outcomes. Further studies are needed to confirm these results.


Subject(s)
Brain Neoplasms/therapy , Chemoradiotherapy/methods , Cranial Irradiation/methods , Glioblastoma/therapy , Stem Cell Niche/radiation effects , Adult , Aged , Aged, 80 and over , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/mortality , Brain Neoplasms/pathology , Chemoradiotherapy/adverse effects , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/prevention & control , Cohort Studies , Cranial Irradiation/adverse effects , Female , Glioblastoma/mortality , Glioblastoma/pathology , Hippocampus/radiation effects , Humans , Lateral Ventricles/radiation effects , Male , Middle Aged , Neural Stem Cells/radiation effects , Prospective Studies , Temozolomide/therapeutic use
2.
Brain Res ; 1727: 146548, 2020 01 15.
Article in English | MEDLINE | ID: mdl-31715143

ABSTRACT

Cranial irradiation is used in combination with other therapies as a treatment for brain tumours and is thought to contribute to long-term cognitive deficits. Several rodent models have demonstrated that these cognitive deficits may be correlated with damage to neural progenitor cells in the subventricular zone (SVZ) and dentate gyrus (DG), the two neurogenic niches of the brain. Studies in rodent models typically assess the proliferating progenitor population, but rarely investigate the effect of cranial irradiation on the neural stem cell pool. Further, few studies evaluate the effects in juveniles, an age when children typically receive this treatment. Herein, we examine the cellular and behavioural effects of juvenile cranial irradiation on stem and progenitor populations in the two neurogenic regions of the brain and assess cognitive outcomes. We found regionally distinct effects of cranial irradiation in the juvenile brain. In the SVZ, we observed a defect in the stem cell pool and a concomitant decrease in proliferating cells that were maintained for at least one week. In the DG, a similar defect in the stem cell pool and proliferating cells was observed and persisted in the stem cell population. Finally, we demonstrated that cranial irradiation resulted in late cognitive deficits. This study demonstrates that juvenile cranial irradiation leads to regionally distinct defects in the stem and progenitor populations, and late cognitive deficits, which may be important factors in determining therapeutic targets and timing of interventions following cranial irradiation.


Subject(s)
Cognitive Dysfunction/etiology , Cranial Irradiation , Dentate Gyrus/radiation effects , Lateral Ventricles/radiation effects , Neural Stem Cells/radiation effects , Animals , Dentate Gyrus/pathology , Lateral Ventricles/pathology , Memory/radiation effects , Mice, Inbred C57BL , Neural Stem Cells/pathology , Stem Cell Niche/radiation effects , Stem Cells/pathology , Stem Cells/radiation effects
3.
Phys Med ; 68: 35-40, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31733404

ABSTRACT

PURPOSE: The aim of this retrospective study was to investigate the relationship between the dose to the subventricular zone (SVZ) and overall survival (OS) of 41 patients with glioblastoma multiforme (GBM), who were treated with an adaptive approach involving repeated topometric CT and replanning at two-thirds (40 Gy) of their course of postoperative radiotherapy for planning of a 20 Gy boost. METHODS: We examined changes in the ipsilateral lateral ventricle (LV) and SVZ (iLV and iSVZ), as well as in the contralateral LV and SVZ (cLV and cSVZ). We evaluated the volumetric changes on both planning CT scans (primary CT1 and secondary CT2). The survival of the GBM patients was analyzed using the Kaplan-Meier method; the multivariate Cox regression was also performed. RESULTS: Median follow-up and OS were 34.5 months and 17.6 months, respectively. LV and SVZ structures exhibited significant volumetric changes on CT2, resulting in an increase of dose coverage. At a cut-off point of 58 Gy, a significant correlation was detected between the iSVZ2 mean dose and OS (27.8 vs 15.6 months, p = 0.048). In a multivariate analysis, GBM patients with a shorter time to postoperative chemoradiotherapy (<3.8 weeks), with good performance status (≥70%) and higher mean dose (≥58 Gy) to the iSVZ2 had significantly better OS. CONCLUSIONS: Significant anatomical and dose distribution changes to the brain structures were observed, which have a relevant impact on the dose-effect relationship for GBM; therefore, involving the iSVZ in the target volume should be considered and adapted to the changes.


Subject(s)
Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Lateral Ventricles/radiation effects , Adult , Brain Neoplasms/diagnostic imaging , Female , Humans , Lateral Ventricles/diagnostic imaging , Male , Postoperative Period , Radiometry , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Survival Analysis , Tomography, X-Ray Computed
4.
Int J Radiat Oncol Biol Phys ; 104(4): 852-858, 2019 07 15.
Article in English | MEDLINE | ID: mdl-30940528

ABSTRACT

PURPOSE: We reviewed the outcomes of a retrospective germinoma cohort and analyzed radiation therapy plans to determine dosimetric differences for critical structures. METHODS AND MATERIALS: Data from pediatric patients treated with photon radiation for intracranial germinoma were analyzed for clinical outcomes and dosimetry to critical structures, with particular interest in the temporal ventricular horns (TVHs). A consensus contour was generated for TVH-sparing ventricular clinical target volumes (CTVs) via deformable image registration. RESULTS: Twelve and 10 patients had their TVHs included or excluded in their ventricular CTVs, respectively. All patients were living at the time of analysis. One patient relapsed in the fourth ventricle, which had been omitted from the radiation therapy field. Mean dose was significantly lower to the hippocampi (Δ = -578 cGy, P = .0016) and temporal lobes (Δ = -599 cGy, P = .0007) in the TVH-excluded cohort compared with those with TVHs included in the treatment field. CONCLUSIONS: Exclusion of the TVHs from the CTV results in significant dose sparing to the hippocampi and temporal lobes. Clinical outcomes remain excellent with no deaths and no TVH failures. Exclusion of TVHs from the ventricular CTV in germinoma requires prospective study.


Subject(s)
Brain Neoplasms/radiotherapy , Germinoma/radiotherapy , Lateral Ventricles/radiation effects , Organ Sparing Treatments , Temporal Lobe/radiation effects , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/drug therapy , Female , Germinoma/drug therapy , Humans , Male , Radiotherapy Dosage , Retrospective Studies , Treatment Outcome
5.
J Cancer Res Ther ; 14(6): 1202-1206, 2018.
Article in English | MEDLINE | ID: mdl-30488830

ABSTRACT

PURPOSE: Glioblastoma (GBM) is characterized by early relapse and mortality. Treatment resistance could be a characteristic exhibited by pro-genitor neoplastic cells that reside in the subventricular zone (SVZ). This retrospective study was conducted to assess the correlation of SVZ doses and survival in patients with GBM. MATERIALS AND METHODS: Forty-seven patients with GBM treated with radiotherapy, concurrent and adjuvant temozolomide therapy, and whose dosimetry data were available were included. The ipsilateral and contralateral SVZs were delineated on co-registered magnetic resonance imaging-computed tomography images as a 5-mm margin along the lateral wall of the lateral ventricles. Median radiotherapy dose prescribed was 59.4 Gy. The mean ipsilateral, contralateral, and bilateral SVZ doses were 56.3 Gy (range 33-63 Gy), 50.4 Gy (range 23-79 Gy), and 52 Gy (28-69 Gy). The progression-free survival (PFS) and overall survival (OS) were calculated from the date of surgery to the date of radiologic and/or clinical progression and death/last follow-up, respectively. Survival probability was estimated using the Kaplan-Meier method. Log-rank test was used to test the significance between groups. Cox proportional hazards analyses were used to identify prognostic factors. RESULTS: At a median follow-up of 19 months, all patients had relapsed. Most recurrences were infield (n = 39). The median PFS and OS were 17 and 19 months, respectively. The PFS and OS at 2 years were 36.2% and 21.3%, respectively. Patients who received ipsilateral SVZ dose of ≥56 Gy appeared to have better but nonsignificant median PFS and OS. Patients receiving contralateral SVZ doses ≥50 Gy showed a similar trend. Only the number of adjuvant temozolomide (≥6 cycles) showed prognostic impact. CONCLUSION: This retrospective study indicated a trend toward improved-albeit nonsignificant-survival with higher dose to the ipsilateral and contralateral SVZs. A well-designed prospective randomized study is required to identify patients who would benefit from intentional SVZ targeting.


Subject(s)
Brain Neoplasms/mortality , Chemoradiotherapy/mortality , Glioblastoma/mortality , Lateral Ventricles/radiation effects , Adult , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/pathology , Brain Neoplasms/therapy , Dacarbazine/therapeutic use , Female , Follow-Up Studies , Glioblastoma/pathology , Glioblastoma/therapy , Humans , Male , Middle Aged , Prognosis , Radiotherapy Dosage , Retrospective Studies , Survival Rate
6.
J Neurooncol ; 136(2): 413-419, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29273890

ABSTRACT

We aimed to assess the efficacy of stereotactic irradiation for patients with recurrent high-grade glioma (HGG) and identify predictive factors of progression-free survival (PFS) and overall survival (OS) following reirradiation. We identified 32 patients with recurrent brain HGG who had been treated with either single-dose (stereotactic radiosurgery) or fractionated stereotactic radiotherapy between April 2008 and October 2015. Median follow up was 21.4 months (range 12.9-23.2) and median PFS was and 3.3 months (95% CI [2.3-4.7]), respectively. OS was 90.40% (95% CI [73.09-96.80]) at 6 months and 79.55% (95% CI [59.9-90.29]) at 12 months. Univariate analysis showed that biological effective dose at isocenter ≤ 76 Gy was a poor prognostic factor for both OS (83.33 vs. 100% at 6 months, p = 0.032) and median PFS (2.7 vs. 4.7 months, p = 0.025), as was gross tumor volume (GTV) above 1 cm3 for OS (86.15 vs. 94.12% at 6 months, p = 0.043). Contact with the subventricular zone (SVZ) was also a poor prognostic factor for median PFS (2.3 vs. 4.7 months, p = 0.002). Multivariate analysis showed that SVZ contact remained a poor prognostic factor for PFS (hazard ratio = 3.44, 95% CI [1.21-9.82], p = 0.021). Results suggest that reirradiation is a safe and effective treatment option for recurrent HGG in patients with a good Karnosfsky Performance Scale score, a long progression-free interval since first radiation and limited GTV, and that contact to SVZ is a strong prognostic factor for PFS.


Subject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/radiotherapy , Glioma/diagnosis , Glioma/radiotherapy , Lateral Ventricles/radiation effects , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/radiotherapy , Re-Irradiation , Adolescent , Adult , Aged , Aged, 80 and over , Dose Fractionation, Radiation , Humans , Kaplan-Meier Estimate , Middle Aged , Neoplasm Grading , Prognosis , Progression-Free Survival , Radiosurgery , Young Adult
7.
J Mol Neurosci ; 63(2): 198-205, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28871488

ABSTRACT

Neural stem cells are self-renewing, multipotent cells that can be found in subventricular (SVZ) and subgranular (SGZ) zones of the brain. These zones are susceptible to irradiation-induced apoptosis and oxidative stress. Melatonin (MLT) is a natural protector of neural cells against toxicity. The aim of this study was to evaluate the effects of MLT as a radio-protective material effective in reducing tissue lesions in the SVZ of the brain and changing local apoptotic potential in rats. Twenty-five Gray irradiation was applied on adult rat brain for this study. One hour before irradiation, 100 mg/kg/IP MLT was injected, and 6 h later, the animals were sacrificed. The antioxidant enzymes and MDA activity levels were measured post-sacrifice. Also, the expression level of Nestin and caspase 3 were studied by immunohistochemistry. Spectrophotometric analysis showed significant increases in the amount of malondialdehyde (MDA) levels in the irradiation-exposed (RAD) group compared to that of the control (Co) group (P < 0.05). Pre-treatment with MLT (100 mg/kg) ameliorates the harmful effects of the aforementioned 25 Gy irradiation by increasing antioxidant enzyme activity and decreasing MDA levels. A significant reduction in apoptotic cells was observed in rats treated with MLT 1 h before exposure (P < 0.001). Nestin-positive cells were also reduced in the RAD group (P < 0.001). Our results confirm the anti-apoptotic and antioxidant role of MLT. The MLT concentration used may serve as a threshold for significant protection against 25 Gy gamma irradiations on neural stem cells in SVZ.


Subject(s)
Apoptosis , Lateral Ventricles/drug effects , Melatonin/pharmacology , Nestin/metabolism , Radiation Injuries/prevention & control , Radiation-Protective Agents/pharmacology , Animals , Lateral Ventricles/metabolism , Lateral Ventricles/radiation effects , Male , Melatonin/administration & dosage , Melatonin/therapeutic use , Nestin/genetics , Radiation Injuries/drug therapy , Radiation, Ionizing , Radiation-Protective Agents/administration & dosage , Radiation-Protective Agents/therapeutic use , Rats , Rats, Sprague-Dawley , Up-Regulation
8.
PLoS Biol ; 15(5): e2001264, 2017 05.
Article in English | MEDLINE | ID: mdl-28489848

ABSTRACT

Stem and differentiated cells frequently differ in their response to DNA damage, which can determine tissue sensitivity. By exploiting insight into the spatial arrangement of subdomains within the adult neural subventricular zone (SVZ) in vivo, we show distinct responses to ionising radiation (IR) between neural stem and progenitor cells. Further, we reveal different DNA damage responses between neonatal and adult neural stem cells (NSCs). Neural progenitors (transit amplifying cells and neuroblasts) but not NSCs (quiescent and activated) undergo apoptosis after 2 Gy IR. This response is cell type- rather than proliferation-dependent and does not appear to be driven by distinctions in DNA damage induction or repair capacity. Moreover, exposure to 2 Gy IR promotes proliferation arrest and differentiation in the adult SVZ. These 3 responses are ataxia telangiectasia mutated (ATM)-dependent and promote quiescent NSC (qNSC) activation, which does not occur in the subdomains that lack progenitors. Neuroblasts arising post-IR derive from activated qNSCs rather than irradiated progenitors, minimising damage compounded by replication or mitosis. We propose that rather than conferring sensitive cell death, apoptosis is a form of rapid cell death that serves to remove damaged progenitors and promote qNSC activation. Significantly, analysis of the neonatal (P5) SVZ reveals that although progenitors remain sensitive to apoptosis, they fail to efficiently arrest proliferation. Consequently, their repopulation occurs rapidly from irradiated progenitors rather than via qNSC activation.


Subject(s)
Apoptosis , DNA Damage , Lateral Ventricles/radiation effects , Neural Stem Cells/radiation effects , Animals , Animals, Newborn , Ataxia Telangiectasia Mutated Proteins/metabolism , Cell Differentiation , Cell Proliferation/radiation effects , Mice, Inbred C57BL , X-Rays
9.
Clin Transl Oncol ; 19(10): 1225-1231, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28389881

ABSTRACT

PURPOSE: To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide. METHODS AND MATERIALS: Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide. RESULTS: Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203). CONCLUSION: High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme.


Subject(s)
Brain Neoplasms/mortality , Dacarbazine/analogs & derivatives , Glioblastoma/mortality , Lateral Ventricles/radiation effects , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/pathology , Brain Neoplasms/therapy , Combined Modality Therapy , Dacarbazine/therapeutic use , Female , Follow-Up Studies , Glioblastoma/pathology , Glioblastoma/therapy , Humans , Male , Middle Aged , Prognosis , Radiation Dosage , Retrospective Studies , Survival Rate , Temozolomide
10.
Radiat Oncol ; 12(1): 67, 2017 Apr 20.
Article in English | MEDLINE | ID: mdl-28424082

ABSTRACT

BACKGROUND: We aimed to identify subventricular zone (SVZ)-related prognostic factors of survival and patterns of recurrence among patients with glioblastoma. METHODS: Forty-three patients with primary diagnosed glioblastoma treated in our Cancer Center between 2006 and 2010 were identified. All patients received surgical resection, followed by temozolomide-based chemoradiation. Ipsilateral (iSVZ), contralateral (cSVZ) and bilateral (bSVZ) SVZs were retrospectively segmented and radiation dose-volume histograms were generated. Multivariate analysis using the Cox proportional hazards model was assessed to examine the relationship between prognostic factors and time to progression (TTP) or overall survival (OS). RESULTS: Median age was 59 years (range: 25-85). Median follow-up, OS and TTP were 22.7 months (range 7.5-69.7 months), 22.7 months (95% CI 14.5-26.2 months) and 6.4 months (95% CI 4.4-9.3 months), respectively. On univariate analysis, initial contact to SVZ was a poor prognostic factor for OS (18.7 vs 41.7 months, p = 0.014) and TTP (4.6 vs 12.9 months, p = 0.002). Patients whose bSVZ volume receiving at least 20 Gy (V20Gy) was greater than 84% had a significantly improved TTP (17.7 months vs 5.2 months, p = 0.017). This radiation dose coverage was compatible with an hippocampal sparing. On multivariate analysis, initial contact to SVZ and V20 Gy to bSVZ lesser than 84% remained poor prognostic factors for TTP (HR = 3.07, p = 0.012 and HR = 2.67, p = 0.047, respectively). CONCLUSION: Our results suggest that contact to SVZ, as well as insufficient bSVZ radiation dose coverage (V20Gy <84%), might be independent poor prognostic factors for TTP. Therefore, targeting SVZ could be of crucial interest for optimizing glioblastoma treatment.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/therapy , Glioblastoma/therapy , Lateral Ventricles/radiation effects , Neoplasm Recurrence, Local/therapy , Adult , Aged , Aged, 80 and over , Brain Neoplasms/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Glioblastoma/pathology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Prognosis , Radiotherapy, Adjuvant , Retrospective Studies , Survival Rate
11.
Neuro Oncol ; 19(1): 66-77, 2017 01.
Article in English | MEDLINE | ID: mdl-27370398

ABSTRACT

BACKGROUND: Patients with glioblastoma (GBM) have an overall median survival of 15 months despite multimodal therapy. These catastrophic survival rates are to be correlated to systematic relapses that might arise from remaining glioblastoma stem cells (GSCs) left behind after surgery. In this line, it has recently been demonstrated that GSCs are able to escape the tumor mass and preferentially colonize the adult subventricular zone (SVZ). At a distance from the initial tumor site, these GSCs might therefore represent a high-quality model of clinical resilience to therapy and cancer relapses as they specifically retain tumor-initiating abilities. METHOD: While relying on recent findings that have validated the existence of GSCs in the human SVZ, we questioned the role of the SVZ niche as a potential GSC reservoir involved in therapeutic failure. RESULTS: Our results demonstrate that (i) GSCs located in the SVZ are specifically resistant to radiation in vivo, (ii) these cells display enhanced mesenchymal roots that are known to be associated with cancer radioresistance, (iii) these mesenchymal traits are specifically upregulated by CXCL12 (stromal cell-derived factor-1) both in vitro and in the SVZ environment, (iv) the amount of SVZ-released CXCL12 mediates GBM resistance to radiation in vitro, and (v) interferes with the CXCL12/CXCR4 signalling system, allowing weakening of the tumor mesenchymal roots and radiosensitizing SVZ-nested GBM cells. CONCLUSION: Together, these data provide evidence on how the adult SVZ environment, through the release of CXCL12, supports GBM therapeutic failure and potential tumor relapse.


Subject(s)
Brain Neoplasms/pathology , Chemokine CXCL12/metabolism , Cranial Irradiation/adverse effects , Glioblastoma/pathology , Lateral Ventricles/pathology , Neoplastic Stem Cells/pathology , Radiation Tolerance , Animals , Brain Neoplasms/metabolism , Brain Neoplasms/radiotherapy , Gamma Rays/adverse effects , Glioblastoma/metabolism , Glioblastoma/radiotherapy , Humans , Lateral Ventricles/metabolism , Lateral Ventricles/radiation effects , Mice , Mice, Nude , Neoplastic Stem Cells/metabolism , Neoplastic Stem Cells/radiation effects , Signal Transduction/radiation effects , Tumor Cells, Cultured
12.
Clin Oncol (R Coll Radiol) ; 29(1): 26-33, 2017 01.
Article in English | MEDLINE | ID: mdl-27729188

ABSTRACT

Glioblastoma is the most common and aggressive adult brain tumour. Over the last 10 years it has emerged that the subventricular zone (SVZ), the largest adult neural stem cell niche, has an important role in the disease. Converging evidence has implicated transformation of adult neural stems in gliomagenesis and the permissive stem cell niche in disease recurrence. Concurrently, clinical studies have suggested that SVZ involvement is a negative prognostic marker. It would follow that irradiating the SVZ may improve outcomes in glioblastoma by directly targeting this putative sanctuary site. To investigate this potential strategy, 11 retrospective studies and 1 prospective study examined the relationship between dose to the SVZ and survival outcomes in glioblastoma patients. This review summarises the theoretical underpinning of this strategy, provides a critical evaluation of the existing evidence and discusses the rationale for a clinical trial.


Subject(s)
Brain Neoplasms/radiotherapy , Glioblastoma/radiotherapy , Lateral Ventricles/radiation effects , Adult , Humans , Male , Neoplastic Stem Cells/radiation effects , Stem Cell Niche/radiation effects
13.
Int J Radiat Biol ; 91(6): 495-9, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25786477

ABSTRACT

PURPOSE: Following in utero exposure to low dose radiation (10-200 mGy), we recently observed a linear induction of DNA double-strand breaks (DSB) and activation of apoptosis in the embryonic neuronal stem/progenitor cell compartment. No significant induction of DSB or apoptosis was observed following exposure to magnetic fields (MF). In the present study, we exploited this in vivo system to examine whether exposure to MF before and after exposure to 100 mGy X-rays impacts upon DSB repair rates. MATERIALS AND METHODS: 53BP1 foci were quantified following combined exposure to radiation and MF in the embryonic neuronal stem/progenitor cell compartment. Embryos were exposed in utero to 50 Hz MF at 300 µT for 3 h before and up to 9 h after exposure to 100 mGy X-rays. Controls included embryos exposed to MF or X-rays alone plus sham exposures. RESULTS: Exposure to MF before and after 100 mGy X-rays did not impact upon the rate of DSB repair in the embryonic neuronal stem cell compartment compared to repair rates following radiation exposure alone. CONCLUSIONS: We conclude that in this sensitive system MF do not exert any significant level of DNA damage and do not impede the repair of X-ray induced damage.


Subject(s)
Brain/metabolism , Brain/radiation effects , DNA Breaks, Double-Stranded , DNA Repair/radiation effects , Magnetic Fields/adverse effects , Animals , Brain/embryology , Embryonic Stem Cells/metabolism , Embryonic Stem Cells/radiation effects , Female , Lateral Ventricles/embryology , Lateral Ventricles/metabolism , Lateral Ventricles/radiation effects , Mice , Mice, Inbred C57BL , Neural Stem Cells/metabolism , Neural Stem Cells/radiation effects , Pregnancy
14.
J Biophotonics ; 8(6): 502-11, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25196192

ABSTRACT

Transcranial low-level laser (light) therapy (LLLT) is a new non-invasive approach to treating a range of brain disorders including traumatic brain injury (TBI). We (and others) have shown that applying near-infrared light to the head of animals that have suffered TBI produces improvement in neurological functioning, lessens the size of the brain lesion, reduces neuroinflammation, and stimulates the formation of new neurons. In the present study we used a controlled cortical impact TBI in mice and treated the mice either once (4 h post-TBI, 1-laser), or three daily applications (3-laser) with 810 nm CW laser 36 J/cm(2) at 50 mW/cm(2). Similar to previous studies, the neurological severity score improved in laser-treated mice compared to untreated TBI mice at day 14 and continued to further improve at days 21 and 28 with 3-laser being better than 1-laser. Mice were sacrificed at days 7 and 28 and brains removed for immunofluorescence analysis. Brain-derived neurotrophic factor (BDNF) was significantly upregulated by laser treatment in the dentate gyrus of the hippocampus (DG) and the subventricular zone (SVZ) but not in the perilesional cortex (lesion) at day 7 but not at day 28. Synapsin-1 (a marker for synaptogenesis, the formation of new connections between existing neurons) was significantly upregulated in lesion and SVZ but not DG, at 28 days but not 7 days. The data suggest that the benefit of LLLT to the brain is partly mediated by stimulation of BDNF production, which may in turn encourage synaptogenesis. Moreover the pleiotropic benefits of BDNF in the brain suggest LLLT may have wider applications to neurodegenerative and psychiatric disorders. Neurological Severity Score (NSS) for TBI mice.


Subject(s)
Brain Injuries/radiotherapy , Brain-Derived Neurotrophic Factor/metabolism , Dentate Gyrus/radiation effects , Lateral Ventricles/radiation effects , Low-Level Light Therapy/methods , Synapsins/metabolism , Animals , Brain Injuries/physiopathology , Dentate Gyrus/metabolism , Disease Models, Animal , Fluorescent Antibody Technique , Lateral Ventricles/metabolism , Male , Mice, Inbred BALB C , Severity of Illness Index , Synapses/metabolism , Synapses/radiation effects , Treatment Outcome
16.
J Neurooncol ; 118(2): 413-419, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24668610

ABSTRACT

To test the hypothesis on prolonged survival in glioblastoma cases with increased subventricular zone (SVZ) radiation dose. Sixty glioblastoma cases were previously treated with adjuvant radiotherapy and Temozolamide. Ipsilateral, contralateral and bilateral SVZs were contoured and their doses were retrospectively evaluated. Median follow-up, progression free survival (PFS) and overall survival (OS) were 24.5, 8.5 and 19.3 months respectively. Log-rank tests showed a statistically significant correlation between contralateral SVZ (cSVZ) dose > 59.2 Gy (75th percentile) and poor median PFS (10.37 [95% CI 8.37-13.53] vs 7.1 [95% CI 3.5-8.97] months, p = 0.009). cSVZ dose > 59.2 Gy was associated with poor OS in the subgroup with subtotal resection/biopsy (HR: 4.83 [95% CI 1.71-13.97], p = 0.004). High ipsilateral SVZ dose of > 62.25 Gy (75th percentile) was associated with poor PFS in both subgroups of high performance status (HR: 2.58 [95% CI 1.03-6.05], p = 0.044) and SVZ without tumoral contact (HR: 10.57 [95% CI 2.04-49], p = 0.008). The effect of high cSVZ dose on PFS lost its statistical significance in multivariate Cox regression analysis. We report contradictory results compared to previous publications. Changing the clinical practice based on retrospective studies which even do not indicate consistent results among each other will be dangerous. We need carefully designed prospective randomized studies to evaluate any impact of radiation to SVZ in glioblastoma.


Subject(s)
Brain Neoplasms/therapy , Chemoradiotherapy , Glioblastoma/therapy , Lateral Ventricles/radiation effects , Adult , Aged , Aged, 80 and over , Antineoplastic Agents, Alkylating/therapeutic use , Dacarbazine/analogs & derivatives , Dacarbazine/therapeutic use , Disease-Free Survival , Female , Follow-Up Studies , Humans , Lateral Ventricles/drug effects , Male , Middle Aged , Proportional Hazards Models , Radiotherapy Dosage , Radiotherapy, Adjuvant , Temozolomide , Treatment Outcome , Young Adult
17.
PLoS One ; 7(11): e49912, 2012.
Article in English | MEDLINE | ID: mdl-23209615

ABSTRACT

Here we demonstrate, both in vivo and in vitro, that growth hormone (GH) mediates precursor cell activation in the subventricular zone (SVZ) of the aged (12-month-old) brain following exercise, and that GH signaling stimulates precursor activation to a similar extent to exercise. Our results reveal that both addition of GH in culture and direct intracerebroventricular infusion of GH stimulate neural precursor cells in the aged brain. In contrast, no increase in neurosphere numbers was observed in GH receptor null animals following exercise. Continuous infusion of a GH antagonist into the lateral ventricle of wild-type animals completely abolished the exercise-induced increase in neural precursor cell number. Given that the aged brain does not recover well after injury, we investigated the direct effect of exercise and GH on neural precursor cell activation following irradiation. This revealed that physical exercise as well as infusion of GH promoted repopulation of neural precursor cells in irradiated aged animals. Conversely, infusion of a GH antagonist during exercise prevented recovery of precursor cells in the SVZ following irradiation.


Subject(s)
Dentate Gyrus/metabolism , Growth Hormone/metabolism , Lateral Ventricles/metabolism , Neural Stem Cells/metabolism , Physical Conditioning, Animal , Age Factors , Animals , Dentate Gyrus/drug effects , Dentate Gyrus/radiation effects , Female , Growth Hormone/administration & dosage , Growth Hormone/pharmacology , Lateral Ventricles/drug effects , Lateral Ventricles/radiation effects , Mice , Mice, Knockout , Neural Stem Cells/drug effects , Receptors, Somatotropin/genetics , Receptors, Somatotropin/metabolism
18.
Stem Cells ; 30(3): 537-47, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22162343

ABSTRACT

The cyclin-dependent kinase inhibitor p21(waf1/cip) mediates the p53-dependent G1/S checkpoint, which is generally considered to be a critical requirement to maintain genomic stability after DNA damage. We used staggered 5-ethynyl-2'deoxyuridine/5-bromo-2'-deoxyuridine double-labeling in vivo to investigate the cell cycle progression and the role of p21(waf1/cip) in the DNA damage response of neural stem and progenitor cells (NSPCs) after exposure of the developing mouse cortex to ionizing radiation. We observed a radiation-induced p21-dependent apoptotic response in migrating postmitotic cortical cells. However, neural stem and progenitor cells (NSPCs) did not initiate a p21(waf1/cip1) -dependent G1/S block and continued to enter S-phase at a similar rate to the non-irradiated controls. The G1/S checkpoint is not involved in the mechanisms underlying the faithful transmission of the NSPC genome and/or the elimination of critically damaged cells. These processes typically involve intra-S and G2/M checkpoints that are rapidly activated after irradiation. p21 is normally repressed in neural cells during brain development except at the G1 to G0 transition. Lack of activation of a G1/S checkpoint and apoptosis of postmitotic migrating cells after DNA damage appear to depend on the expression of p21 in neural cells, since substantial cell-to-cell variations are found in the irradiated cortex. This suggests that repression of p21 during brain development prevents the induction of the G1/S checkpoint after DNA damage.


Subject(s)
Cyclin-Dependent Kinase Inhibitor p21/deficiency , DNA Damage , G1 Phase Cell Cycle Checkpoints/radiation effects , Neural Stem Cells/physiology , Animals , Apoptosis , Cell Nucleus/metabolism , Cell Proliferation/radiation effects , Cyclin-Dependent Kinase Inhibitor p21/genetics , Cyclin-Dependent Kinase Inhibitor p21/physiology , Embryo, Mammalian/radiation effects , Female , Genomic Instability/radiation effects , Lateral Ventricles/metabolism , Lateral Ventricles/pathology , Lateral Ventricles/radiation effects , Mice , Mice, 129 Strain , Mice, Inbred C57BL , Mice, Knockout , Neural Stem Cells/metabolism , Neural Stem Cells/radiation effects , Neuroglia/physiology , Neuroglia/radiation effects , Pregnancy , S Phase Cell Cycle Checkpoints/radiation effects , Statistics, Nonparametric
19.
Cell Mol Neurobiol ; 29(6-7): 981-90, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19305951

ABSTRACT

It is well established that strong electromagnetic fields (EMFs) can give rise to acute health effects, such as burns, which can be effectively prevented by respecting exposure guidelines and regulations. Current concerns are instead directed toward the possibility that long-term exposure to weak EMF might have detrimental health effects due to some biological mechanism, to date unknown. (1) The possible risk due to pulsed EMF at frequency 2.45 GHz and mean power density 2.8 mW/cm(2) on rat postnatal neurogenesis was studied in relation to the animal's age, duration of the exposure dose, and post-irradiation survival. (2) Proliferating cells marker, BrdU, was used to map age- and dose-related immunohistochemical changes within the rostral migratory stream (RMS) after whole-body exposure of newborn (P7) and senescent (24 months) rats. (3) Two dose-related exposure patterns were performed to clarify the cumulative effect of EMF: short-term exposure dose, 2 days irradiation (4 h/day), versus long-term exposure dose, 3 days irradiation (8 h/day), both followed by acute (24 h) and chronic (1-4 weeks) post-irradiation survival. (4) We found that the EMF induces significant age- and dose-dependent changes in proliferating cell numbers within the RMS. Our results indicate that the concerns about the possible risk of EMF generated in connection with production, transmission, distribution, and the use of electrical equipment and communication sets are justified at least with regard to early postnatal neurogenesis.


Subject(s)
Brain/radiation effects , Electromagnetic Fields , Lateral Ventricles/radiation effects , Neurogenesis/radiation effects , Age Factors , Animals , Animals, Newborn , Bromodeoxyuridine , Dose-Response Relationship, Radiation , Immunohistochemistry , Rats , Rats, Wistar , Whole-Body Irradiation
20.
Proc Natl Acad Sci U S A ; 105(50): 19587-94, 2008 Dec 16.
Article in English | MEDLINE | ID: mdl-19060186

ABSTRACT

The neural circuits that regulate sleep and arousal as well as their integration with circadian circuits remain unclear, especially in Drosophila. This issue intersects with that of photoreception, because light is both an arousal signal in diurnal animals and an entraining signal for the circadian clock. To identify neurons and circuits relevant to light-mediated arousal as well as circadian phase-shifting, we developed genetic techniques that link behavior to single cell-type resolution within the Drosophila central brain. We focused on the unknown function of the 10 PDF-containing large ventral lateral neurons (l-LNvs) of the Drosophila circadian brain network and show here that these cells function in light-dependent arousal. They also are important for phase shifting in the late-night (dawn), indicating that the circadian photoresponse is a network property and therefore non-cell-autonomous. The data further indicate that the circuits underlying light-induced arousal and circadian photoentrainment intersect at the l-LNvs and then segregate.


Subject(s)
Arousal , Circadian Rhythm , Drosophila melanogaster/physiology , Lateral Ventricles/physiology , Photoreceptor Cells, Invertebrate/physiology , Sleep , Animals , Drosophila Proteins/metabolism , Drosophila melanogaster/genetics , Drosophila melanogaster/radiation effects , Lateral Ventricles/cytology , Lateral Ventricles/radiation effects , Light , Nerve Net/cytology , Nerve Net/physiology , Nerve Net/radiation effects , Photoreceptor Cells, Invertebrate/cytology , Photoreceptor Cells, Invertebrate/radiation effects , Receptors, G-Protein-Coupled/metabolism
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