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Author (up) Achari, R.; Arunsingh, M.; Badgami, R.K.; Saha, A.; Chatterjee, S.; Shrimali, R.K.; Mallick, I.; Arun, B. url  doi
  Title High-dose Neural Stem Cell Radiation May Not Improve Survival in Glioblastoma Type Journal Article
  Year 2017 Publication Clinical Oncology (Royal College of Radiologists (Great Britain)) Abbreviated Journal Clin Oncol (R Coll Radiol)  
  Volume 29 Issue 6 Pages 335-343  
  Keywords Adult; Aged; Antineoplastic Agents, Alkylating/therapeutic use; Brain Neoplasms/diagnostic imaging/pathology/*therapy; *Chemoradiotherapy, Adjuvant; Contrast Media; DNA Modification Methylases/metabolism; DNA Repair Enzymes/metabolism; Dacarbazine/analogs & derivatives/therapeutic use; Disease-Free Survival; Female; Follow-Up Studies; Glioblastoma/diagnostic imaging/*therapy; Humans; Magnetic Resonance Imaging; Male; Medication Adherence; Middle Aged; Neural Stem Cells/*radiation effects; Radiotherapy Dosage; Survival Rate; Tomography, X-Ray Computed; Tumor Suppressor Proteins/metabolism; Glioblastoma; neural stem cell; radiation therapy; survival  
  Abstract AIMS: To evaluate the effect of radiotherapy dose-volume parameters of neural stem cell (NSC) compartment on progression-free survival (PFS) and overall survival after post-resection chemoradiation in newly diagnosed glioblastoma. MATERIALS AND METHODS: Sixty-one patients with unifocal glioblastoma were included. Ipsilateral (NSCIpsi), contralateral (NSCContra) and combined NSC (NSCCombined) were contoured on radiotherapy planning computerised tomography datasets. NSC dose-volume parameters were correlated with PFS and overall survival. Serial magnetic resonance imaging scans were assessed to understand the frequency of pre- and post-treatment involvement of the NSC by contrast enhancing lesions (CELs). RESULTS: Baseline involvement of NSC with CELs was seen in 67.2% and 95.9% had CELs and FLAIR abnormalities at progression. With a median follow-up of 14.1 months (interquartile range 9.4-20.6 months), median PFS and overall survival were 14.5 (95% confidence interval 11.6-17.5) and 16.2 (95% confidence interval 13.3-19.2) months, respectively. Poor Eastern Cooperative Oncology Group performance score, advanced recursive partitioning analysis class, unmethylated O6-methylguanine methyltransferase (MGMT) status, higher than median of mean NSCIpsi dose were associated with significantly inferior PFS and overall survival on univariate analysis. On multivariate analysis, unmethylated MGMT status, higher than median of mean doses to NSCIpsi and poor compliance to adjuvant temozolomide were independent predictors of inferior survival. CONCLUSIONS: In this cohort, 67.2% of newly diagnosed glioblastoma patients had NSC involved with CELs at presentation and 95.9% at progression. This might be an imaging surrogate of the current notion of gliomagenesis and progression from NSC rests. A high radiation dose to NSCIpsi was significantly associated with inferior survival. This could be a function of larger tumours and planning target volumes in those with pre-treatment NSC involvement. Methylated MGMT and good compliance to adjuvant temozolomide were independent predictors of better survival. Until further evidence brings hope for glioblastoma, elective, partial NSC irradiation remains experimental.  
  Address Department of Medical Physics, Tata Medical Center, Kolkata, India  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0936-6555 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:28188088 Approved no  
  Call Number ref @ user @ Serial 96609  
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