Proceedings/Recueil Des Communications Brain and Spine Année : 2021

Glioblastoma heterogeneity and cancer stem-like cells detection with advanced MRI in the non contrast enhancing tumor: time to personalized surgery and therapeutic paradigm shift?

Résumé

Background: With current gold standard treatment, which associates maximum safe surgery and chemo-radiation, the large majority of glioblastoma patients relapse within a year with a progression in the peritumoral region. A subpopulation of glioblastoma stem-like cells (GSC) are known to be particularly radio-resistant and aggressive, and are thus suspected to be the cause of these relapses in the peritumoral non contrast-enhanced region (NCE). Previous studies have shown that their distribution is heterogeneous in the nCE compartment, but none investigated the spatial localization of these cells is unknown since no study exists on the sensitivity of medical imaging for localizing these cells. In this work, we propose to study the magnetic resonance (MR) signature of these infiltrative cells. Methods: In the context of a clinical trial (NCT01872221), image-guided targeted biopsies were extracted intraoperatively during surgical resection from 16 glioblastoma patients in the hyper-FLAIR region and GSC subpopulation was quantified within the biopsy and then cultivated in selective conditions to determine their density and aggressiveness. Cortico-subcortical mapping was performed to optimize extent of resection and safety. Results: Diffusion MR was found to be a good predictor of the time to form GSC neurospheres in vitro. GSCs were found in higher concentrations in locations with strong perfusion (i.e. near vascular niches). Conclusion: This study confirms that GSCs have a critical role for glioblastoma recurrence and supports the idea that peritumoral sites with low ADC or high rCBV, provided functional safety, should be preferably removed during surgery, since radiotherapy and chemotherapy have a poor efficacy on GSCs.

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Dates et versions

hal-04852285 , version 1 (20-12-2024)

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T. Duval, J.-A. Lotterie, A. Lemarie, C. Delmas, R. Howells, et al.. Glioblastoma heterogeneity and cancer stem-like cells detection with advanced MRI in the non contrast enhancing tumor: time to personalized surgery and therapeutic paradigm shift?. eEANS (European Association of Neurosurgical Societies) 2021, Brain and Spine, 1, pp.100512, 2021, ⟨10.1016/j.bas.2021.100512⟩. ⟨hal-04852285⟩
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