1
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Duffau H. Oncological and functional neurosurgery: Perspectives for the decade regarding diffuse gliomas. Rev Neurol (Paris) 2023; 179:437-448. [PMID: 36907710 DOI: 10.1016/j.neurol.2023.01.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 03/12/2023]
Abstract
For decades, diffuse glioma (DG) studies mostly focused on oncological considerations, whereas functional outcomes received less attention. Currently, because overall survival has increased in DG, especially in low-grade glioma (overall survival > 15 years), quality of life including neurocognitive and behavioral aspects should be assessed and preserved more systematically, particularly regarding surgery. Indeed, early maximal tumor removal results in greater survival in both high-grade and low-grade gliomas, leading to propose "supra-marginal" resection, with excision of the peritumoral zone in diffuse neoplasms. To minimize functional risks while maximizing the extent of resection, traditional "tumor-mass resection" is replaced by "connectome-guided resection" conducted under awake mapping, taking into account inter-individual brain anatomo-functional variability. A better understanding of the dynamic interplay between DG progression and reactional neuroplastic mechanisms is critical to adapt a personalized multistage therapeutic strategy, with integration of functional neurooncological (re)operation(s) in a multimodal management scheme including repeated medical therapies. Because the therapeutic armamentarium remains limited, the aims of this paradigmatic shift are to predict one/several step(s) ahead glioma behavior, its modifications, and compensatory neural networks reconfiguration over time in order to optimize the onco-functional benefit of each treatment - either in isolation or in combination with others - in human beings bearing a chronic tumoral disease while enjoying an active familial and socio-professional life as close as possible to their expectations. Thus, new ecological endpoints such as return to work should be incorporated into future DG trials. "Preventive neurooncology" might also be envisioned, by proposing a screening policy to discover and treat incidental glioma earlier.
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Affiliation(s)
- H Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", National Institute for Health and Medical Research (Inserm), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France.
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2
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Duffau H. A Personalized Longitudinal Strategy in Low-Grade Glioma Patients: Predicting Oncological and Neural Interindividual Variability and Its Changes over Years to Think One Step Ahead. J Pers Med 2022; 12:jpm12101621. [PMID: 36294760 PMCID: PMC9604939 DOI: 10.3390/jpm12101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Diffuse low-grade glioma (LGG) is a rare cerebral cancer, mostly involving young adults with an active life at diagnosis. If left untreated, LGG widely invades the brain and becomes malignant, generating neurological worsening and ultimately death. Early and repeat treatments for this incurable tumor, including maximal connectome-based surgical resection(s) in awake patients, enable postponement of malignant transformation while preserving quality of life owing to constant neural network reconfiguration. Due to considerable interindividual variability in terms of LGG course and consecutive cerebral reorganization, a multistage longitudinal strategy should be tailored accordingly in each patient. It is crucial to predict how the glioma will progress (changes in growth rate and pattern of migration, genetic mutation, etc.) and how the brain will adapt (changes in patterns of spatiotemporal redistribution, possible functional consequences such as epilepsy or cognitive decline, etc.). The goal is to anticipate therapeutic management, remaining one step ahead in order to select the optimal (re-)treatment(s) (some of them possibly kept in reserve), at the appropriate time(s) in the evolution of this chronic disease, before malignization and clinical worsening. Here, predictive tumoral and non-tumoral factors, and their ever-changing interactions, are reviewed to guide individual decisions in advance based on patient-specific markers, for the treatment of LGG.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av. Augustin Fliche, 34295 Montpellier, France; ; Tel.: +33-4-67-33-66-12; Fax: +33-4-67-33-69-12
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors”, National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France
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3
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Duffau H. White Matter Tracts and Diffuse Lower-Grade Gliomas: The Pivotal Role of Myelin Plasticity in the Tumor Pathogenesis, Infiltration Patterns, Functional Consequences and Therapeutic Management. Front Oncol 2022; 12:855587. [PMID: 35311104 PMCID: PMC8924360 DOI: 10.3389/fonc.2022.855587] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022] Open
Abstract
For many decades, interactions between diffuse lower-grade glioma (LGG) and brain connectome were neglected. However, the neoplasm progression is intimately linked to its environment, especially the white matter (WM) tracts and their myelin status. First, while the etiopathogenesis of LGG is unclear, this tumor seems to appear during the adolescence, and it is mostly located within anterior and associative cerebral areas. Because these structures correspond to those which were myelinated later in the brain maturation process, WM myelination could play a role in the development of LGG. Second, WM fibers and the myelin characteristics also participate in LGG diffusion, since glioma cells migrate along the subcortical pathways, especially when exhibiting a demyelinated phenotype, which may result in a large invasion of the parenchyma. Third, such a migratory pattern can induce functional (neurological, cognitive and behavioral) disturbances, because myelinated WM tracts represent the main limitation of neuroplastic potential. These parameters are critical for tailoring an individualized therapeutic strategy, both (i) regarding the timing of active treatment(s) which must be proposed earlier, before a too wide glioma infiltration along the WM bundles, (ii) and regarding the anatomic extent of surgical resection and irradiation, which should take account of the subcortical connectivity. Therefore, the new science of connectomics must be integrated in LGG management, based upon an improved understanding of the interplay across glioma dissemination within WM and reactional neural networks reconfiguration, in order to optimize long-term oncological and functional outcomes. To this end, mechanisms of activity-dependent myelin plasticity should be better investigated.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM) U1191, University of Montpellier, Montpellier, France
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4
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Adenis L, Plaszczynski S, Grammaticos B, Pallud J, Badoual M. The Effect of Radiotherapy on Diffuse Low-Grade Gliomas Evolution: Confronting Theory with Clinical Data. J Pers Med 2021; 11:jpm11080818. [PMID: 34442462 PMCID: PMC8401413 DOI: 10.3390/jpm11080818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
Diffuse low-grade gliomas are slowly growing tumors that always recur after treatment. In this paper, we revisit the modeling of the evolution of the tumor radius before and after the radiotherapy process and propose a novel model that is simple yet biologically motivated and that remedies some shortcomings of previously proposed ones. We confront this with clinical data consisting of time series of tumor radii from 43 patient records by using a stochastic optimization technique and obtain very good fits in all cases. Since our model describes the evolution of a tumor from the very first glioma cell, it gives access to the possible age of the tumor. Using the technique of profile likelihood to extract all of the information from the data, we build confidence intervals for the tumor birth age and confirm the fact that low-grade gliomas seem to appear in the late teenage years. Moreover, an approximate analytical expression of the temporal evolution of the tumor radius allows us to explain the correlations observed in the data.
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Affiliation(s)
- Léo Adenis
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
| | - Stéphane Plaszczynski
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
- Correspondence:
| | - Basile Grammaticos
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris, Sainte-Anne Hospital, 75014 Paris, France;
- Université de Paris, Sorbonne Paris Cité, 75014 Paris, France
- Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, 75014 Paris, France
| | - Mathilde Badoual
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
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5
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Budia I, Alvarez-Arenas A, Woolley TE, Calvo GF, Belmonte-Beitia J. Radiation protraction schedules for low-grade gliomas: a comparison between different mathematical models. J R Soc Interface 2019; 16:20190665. [PMID: 31822220 DOI: 10.1098/rsif.2019.0665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We optimize radiotherapy (RT) administration strategies for treating low-grade gliomas. Specifically, we consider different tumour growth laws, both with and without spatial effects. In each scenario, we find the optimal treatment in the sense of maximizing the overall survival time of a virtual low-grade glioma patient, whose tumour progresses according to the examined growth laws. We discover that an extreme protraction therapeutic strategy, which amounts to substantially extending the time interval between RT sessions, may lead to better tumour control. The clinical implications of our results are also presented.
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Affiliation(s)
- I Budia
- Department of Mathematics and MôLAB-Mathematical Oncology Laboratory, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - A Alvarez-Arenas
- Department of Mathematics and MôLAB-Mathematical Oncology Laboratory, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - T E Woolley
- School of Mathematics, Cardiff University, Senghennydd Road, Cardiff CF24 4AG, UK
| | - G F Calvo
- Department of Mathematics and MôLAB-Mathematical Oncology Laboratory, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - J Belmonte-Beitia
- Department of Mathematics and MôLAB-Mathematical Oncology Laboratory, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
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6
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Pérez-García VM, Ayala-Hernández LE, Belmonte-Beitia J, Schucht P, Murek M, Raabe A, Sepúlveda J. Computational design of improved standardized chemotherapy protocols for grade II oligodendrogliomas. PLoS Comput Biol 2019; 15:e1006778. [PMID: 31306418 PMCID: PMC6629055 DOI: 10.1371/journal.pcbi.1006778] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
Here we put forward a mathematical model describing the response of low-grade (WHO grade II) oligodendrogliomas (LGO) to temozolomide (TMZ). The model describes the longitudinal volumetric dynamics of tumor response to TMZ of a cohort of 11 LGO patients treated with TMZ. After finding patient-specific parameters, different therapeutic strategies were tried computationally on the 'in-silico twins' of those patients. Chemotherapy schedules with larger-than-standard rest periods between consecutive cycles had either the same or better long-term efficacy than the standard 28-day cycles. The results were confirmed in a large trial of 2000 virtual patients. These long-cycle schemes would also have reduced toxicity and defer the appearance of resistances. On the basis of those results, a combination scheme consisting of five induction TMZ cycles given monthly plus 12 maintenance cycles given every three months was found to provide substantial survival benefits for the in-silico twins of the 11 LGO patients (median 5.69 years, range: 0.67 to 68.45 years) and in a large virtual trial including 2000 patients. We used 220 sets of experiments in-silico to show that a clinical trial incorporating 100 patients per arm (standard intensive treatment versus 5 + 12 scheme) could demonstrate the superiority of the novel scheme after a follow-up period of 10 years. Thus, the proposed treatment plan could be the basis for a standardized TMZ treatment for LGO patients with survival benefits.
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Affiliation(s)
- Víctor M. Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Luis E. Ayala-Hernández
- Departamento de Ciencias Exactas y Tecnología Centro Universitario de los Lagos, Universidad de Guadalajara, Lagos de Moreno, Mexico
| | - Juan Belmonte-Beitia
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Philippe Schucht
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Michael Murek
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Andreas Raabe
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Juan Sepúlveda
- Oncology Unit, Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
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7
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Duffau H. Higher-Order Surgical Questions for Diffuse Low-Grade Gliomas: Supramaximal Resection, Neuroplasticity, and Screening. Neurosurg Clin N Am 2018; 30:119-128. [PMID: 30470399 DOI: 10.1016/j.nec.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diffuse low-grade glioma (DLGG) is a brain neoplasm that migrates within the connectome and that becomes malignant if left untreated. Early and maximal safe surgical resection by means of awake mapping enables a significant improvement of survival and quality of life. Supramaximal functional-based resection seems to prevent DLGG malignant transformation. Neuroplasticity is helpful to remove DLGG in eloquent areas. When radical excision cannot be achieved due to invasion of critical neural networks, cerebral remapping over time may lead to a reoperation with an optimized resection. To discover and treat DLGG earlier, a screening in the general population should be considered.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier 34295, France; Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neuroscience of Montpellier, INSERM U1051, Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France.
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8
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Alfonso JCL, Talkenberger K, Seifert M, Klink B, Hawkins-Daarud A, Swanson KR, Hatzikirou H, Deutsch A. The biology and mathematical modelling of glioma invasion: a review. J R Soc Interface 2018; 14:rsif.2017.0490. [PMID: 29118112 DOI: 10.1098/rsif.2017.0490] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022] Open
Abstract
Adult gliomas are aggressive brain tumours associated with low patient survival rates and limited life expectancy. The most important hallmark of this type of tumour is its invasive behaviour, characterized by a markedly phenotypic plasticity, infiltrative tumour morphologies and the ability of malignant progression from low- to high-grade tumour types. Indeed, the widespread infiltration of healthy brain tissue by glioma cells is largely responsible for poor prognosis and the difficulty of finding curative therapies. Meanwhile, mathematical models have been established to analyse potential mechanisms of glioma invasion. In this review, we start with a brief introduction to current biological knowledge about glioma invasion, and then critically review and highlight future challenges for mathematical models of glioma invasion.
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Affiliation(s)
- J C L Alfonso
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - K Talkenberger
- Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - M Seifert
- Institute for Medical Informatics and Biometry, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany
| | - B Klink
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany.,German Cancer Consortium (DKTK), partner site, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hawkins-Daarud
- Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, USA
| | - K R Swanson
- Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, USA
| | - H Hatzikirou
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - A Deutsch
- Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
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9
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Dufour A, Gontran E, Deroulers C, Varlet P, Pallud J, Grammaticos B, Badoual M. Modeling the dynamics of oligodendrocyte precursor cells and the genesis of gliomas. PLoS Comput Biol 2018; 14:e1005977. [PMID: 29590097 PMCID: PMC5903643 DOI: 10.1371/journal.pcbi.1005977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/17/2018] [Accepted: 01/10/2018] [Indexed: 11/24/2022] Open
Abstract
Oligodendrocyte precursor cells (OPCs) have remarkable properties: they represent the most abundant cycling cell population in the adult normal brain and they manage to achieve a uniform and constant density throughout the adult brain. This equilibrium is obtained by the interplay of four processes: division, differentiation or death, migration and active self-repulsion. They are also strongly suspected to be at the origin of gliomas, when their equilibrium is disrupted. In this article, we present a model of the dynamics of OPCs, first in a normal tissue. This model is based on a cellular automaton and its rules are mimicking the ones that regulate the dynamics of real OPCs. The model is able to reproduce the homeostasis of the cell population, with the maintenance of a constant and uniform cell density and the healing of a lesion. We show that there exists a fair quantitative agreement between the simulated and experimental parameters, such as the cell velocity, the time taken to close a lesion, and the duration of the cell cycle. We present three possible scenarios of disruption of the equilibrium: the appearance of an over-proliferating cell, of a deadless/non-differentiating cell, or of a cell that lost any contact-inhibition. We show that the appearance of an over-proliferating cell is sufficient to trigger the growth of a tumor that has low-grade glioma features: an invasive behaviour, a linear radial growth of the tumor with a corresponding growth velocity of less than 2 mm per year, as well a cell density at the center which exceeds the one in normal tissue by a factor of less than two. The loss of contact inhibition leads to a more high-grade-like glioma. The results of our model contribute to the body of evidence that identify OPCs as possible cells of origin of gliomas. Gliomas are the most common brain tumors and result in more years of life lost than any other tumor. Standard treatments only confer a limited improvement in overall survival, underscoring the need for new therapies. Finding the type of cells at the origin of these tumors could lead to the development of new drugs, specifically targeted towards these cells. The oligodendrocyte precursor cells are suspected to be these cells of origin, because they continue to proliferate through all the adult life. In this article, we present a model of the dynamics of these cells, first in the normal brain, and then we extrapolate our model to the pathological situation. We study several scenarios where, from the normal situation, a cell appears with one property different from those of the normal cells. We show that the alteration of only one of the properties of these cells in the model can lead to the formation of gliomas with different aggressiveness and very similar to real gliomas, reinforcing the suspicion that the precursor cells are at the origin of gliomas.
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Affiliation(s)
- Aloys Dufour
- IMNC Laboratory, CNRS, Univ Paris Saclay, Univ Paris-Sud, Univ Paris Diderot, France
| | - Emilie Gontran
- IMNC Laboratory, CNRS, Univ Paris Saclay, Univ Paris-Sud, Univ Paris Diderot, France
| | - Christophe Deroulers
- IMNC Laboratory, CNRS, Univ Paris Saclay, Univ Paris-Sud, Univ Paris Diderot, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, IMA-Brain, INSERM U894, Univ Paris Descartes, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, IMA-Brain, INSERM U894, Univ Paris Descartes, Paris, France
| | - Basile Grammaticos
- IMNC Laboratory, CNRS, Univ Paris Saclay, Univ Paris-Sud, Univ Paris Diderot, France
| | - Mathilde Badoual
- IMNC Laboratory, CNRS, Univ Paris Saclay, Univ Paris-Sud, Univ Paris Diderot, France
- * E-mail:
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10
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Proposition de dépistage des gliomes diffus de bas grade dans la population de 20 à 40 ans. Presse Med 2017; 46:911-920. [DOI: 10.1016/j.lpm.2017.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/17/2017] [Accepted: 07/12/2017] [Indexed: 12/30/2022] Open
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11
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Bogdańska MU, Bodnar M, Piotrowska MJ, Murek M, Schucht P, Beck J, Martínez-González A, Pérez-García VM. A mathematical model describes the malignant transformation of low grade gliomas: Prognostic implications. PLoS One 2017; 12:e0179999. [PMID: 28763450 PMCID: PMC5538650 DOI: 10.1371/journal.pone.0179999] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/07/2017] [Indexed: 01/28/2023] Open
Abstract
Gliomas are the most frequent type of primary brain tumours. Low grade gliomas (LGGs, WHO grade II gliomas) may grow very slowly for the long periods of time, however they inevitably cause death due to the phenomenon known as the malignant transformation. This refers to the transition of LGGs to more aggressive forms of high grade gliomas (HGGs, WHO grade III and IV gliomas). In this paper we propose a mathematical model describing the spatio-temporal transition of LGGs into HGGs. Our modelling approach is based on two cellular populations with transitions between them being driven by the tumour microenvironment transformation occurring when the tumour cell density grows beyond a critical level. We show that the proposed model describes real patient data well. We discuss the relationship between patient prognosis and model parameters. We approximate tumour radius and velocity before malignant transformation as well as estimate the onset of this process.
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Affiliation(s)
- Magdalena U. Bogdańska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
- Departamento de Matemáticas, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Marek Bodnar
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Monika J. Piotrowska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Michael Murek
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
| | - Philippe Schucht
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
| | - Jürgen Beck
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
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12
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Martı Nez-González A, Calvo GF, Ayuso JM, Ochoa I, Fernández LJ, Pérez-García VM. Hypoxia in Gliomas: Opening Therapeutical Opportunities Using a Mathematical-Based Approach. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 936:11-29. [PMID: 27739041 DOI: 10.1007/978-3-319-42023-3_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This chapter explores the use of mathematical models as promising and powerful tools to understand the complexity of tumors and their, frequently, hypoxic environment. We focus on gliomas, which are primary brain tumors derived from glial cells, mainly astrocytes and/or oligodendrocytes. A variety of mathematical models, based on ordinary and/or partial differential equations, have been developed both at the micro and macroscopic levels. The aim here is to describe in a quantitative way key physiopathological mechanisms relevant in these types of malignancies and to suggest optimal therapeutical strategies. More specifically, we consider novel therapies targeting thromboembolic phenomena to decrease cell invasion in high grade glioma or to delay the malignant transformation in low grade gliomas. This study has been the basis of a multidisciplinary collaboration involving, among others, neuro-oncologists, radiation oncologists, pathologists, cancer biologists, surgeons and mathematicians.
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Affiliation(s)
- Alicia Martı Nez-González
- Mathematical Oncology Laboratory (MôLAB), University of Castilla-La Mancha, Castilla-La Mancha, Spain
| | - Gabriel F Calvo
- Mathematical Oncology Laboratory (MôLAB), University of Castilla-La Mancha, Castilla-La Mancha, Spain
| | - Jose M Ayuso
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Ignacio Ochoa
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Luis J Fernández
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Víctor M Pérez-García
- Mathematical Oncology Laboratory (MôLAB), University of Castilla-La Mancha, Castilla-La Mancha, Spain.
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13
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Bogdańska M, Bodnar M, Belmonte-Beitia J, Murek M, Schucht P, Beck J, Pérez-García V. A mathematical model of low grade gliomas treated with temozolomide and its therapeutical implications. Math Biosci 2017; 288:1-13. [DOI: 10.1016/j.mbs.2017.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/28/2016] [Accepted: 02/02/2017] [Indexed: 12/14/2022]
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14
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Marongiu A, D'Andrea G, Raco A. 1.5-T Field Intraoperative Magnetic Resonance Imaging Improves Extent of Resection and Survival in Glioblastoma Removal. World Neurosurg 2017; 98:578-586. [DOI: 10.1016/j.wneu.2016.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
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15
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The etiopathogenesis of diffuse low-grade gliomas. Crit Rev Oncol Hematol 2016; 109:51-62. [PMID: 28010898 DOI: 10.1016/j.critrevonc.2016.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022] Open
Abstract
The origins of diffuse low-grade gliomas (DLGG) are unknown. Beyond some limited data on their temporal and cellular origins, the mechanisms and risk factors involved are poorly known. First, based on strong relationships between DLGG development and the eloquence of brain regions frequently invaded by these tumors, we propose a "functional theory" to explain the origin of DLGG. Second, the biological pathways involved in DLGG genesis may differ according to tumor location (anatomo-molecular correlations). The cellular and molecular mechanisms of such "molecular theory" will be reviewed. Third, the geographical distribution of diffuse WHO grade II-III gliomas within populations is heterogeneous, suggesting possible environmental risk factors. We will discuss this "environmental theory". Finally, we will summarize the current knowledge on genetic susceptibility in gliomas ("genetic predisposition theory"). These crucial issues illustrate the close relationships between the pathophysiology of gliomagenesis, the anatomo-functional organization of the brain, and personalized management of DLGG patients.
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16
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Parisot S, Darlix A, Baumann C, Zouaoui S, Yordanova Y, Blonski M, Rigau V, Chemouny S, Taillandier L, Bauchet L, Duffau H, Paragios N. A Probabilistic Atlas of Diffuse WHO Grade II Glioma Locations in the Brain. PLoS One 2016; 11:e0144200. [PMID: 26751577 PMCID: PMC4709135 DOI: 10.1371/journal.pone.0144200] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022] Open
Abstract
Diffuse WHO grade II gliomas are diffusively infiltrative brain tumors characterized by an unavoidable anaplastic transformation. Their management is strongly dependent on their location in the brain due to interactions with functional regions and potential differences in molecular biology. In this paper, we present the construction of a probabilistic atlas mapping the preferential locations of diffuse WHO grade II gliomas in the brain. This is carried out through a sparse graph whose nodes correspond to clusters of tumors clustered together based on their spatial proximity. The interest of such an atlas is illustrated via two applications. The first one correlates tumor location with the patient's age via a statistical analysis, highlighting the interest of the atlas for studying the origins and behavior of the tumors. The second exploits the fact that the tumors have preferential locations for automatic segmentation. Through a coupled decomposed Markov Random Field model, the atlas guides the segmentation process, and characterizes which preferential location the tumor belongs to and consequently which behavior it could be associated to. Leave-one-out cross validation experiments on a large database highlight the robustness of the graph, and yield promising segmentation results.
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Affiliation(s)
- Sarah Parisot
- Center for Visual Computing, Ecole Centrale Paris, Chatenay Malabry, France
- INRIA, Galen Team, Saclay-Ile-de-France Center, Chatenay Malabry, France
- Intrasense SAS, Montpellier, France
| | - Amélie Darlix
- INSERM U1051, Montpellier Neurosciences Institute, University Hospital, Montpellier, France
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
| | - Cédric Baumann
- Department of Clinical Epidemiology and Evaluation, University Hospital, Nancy, France
| | - Sonia Zouaoui
- Department of Epidemiology, Groupe de Neuro-Oncologie du Languedoc-Roussillon, Registre des Tumeurs de l’Hérault, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
| | | | - Marie Blonski
- Neuro-oncology Unit, Department of Neurology, University Hospital, Hôpital Central, Nancy, France
| | - Valérie Rigau
- Department of Pathology, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Luc Taillandier
- Neuro-oncology Unit, Department of Neurology, University Hospital, Hôpital Central, Nancy, France
| | - Luc Bauchet
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
- Department of Neurosurgery, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | - Hugues Duffau
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
- Department of Neurosurgery, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | - Nikos Paragios
- Center for Visual Computing, Ecole Centrale Paris, Chatenay Malabry, France
- INRIA, Galen Team, Saclay-Ile-de-France Center, Chatenay Malabry, France
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17
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Serum microRNAs as potential noninvasive biomarkers for glioma. Tumour Biol 2015; 37:1407-10. [PMID: 26628296 DOI: 10.1007/s13277-015-4515-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/25/2015] [Indexed: 12/20/2022] Open
Abstract
Gliomas are derived from astroglial precursors or astrocytes, accounting for 40 % central nervous system tumors. MicroRNAs (miRNAs) are a class of endogenous, small (19- to 23-nucleotides) non-coding RNAs involved in cancer progression. Recent studies show that circulating miRNAs are associated with the clinicopathological features and prognosis of gliomas. Serum miRNAs may serve as novel biomarkers for gliomas diagnosis. This review explores the possibilities of using serum miRNAs as prognostic, diagnostic markers, and therapeutic targets in gliomas.
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18
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Incidental diffuse low-grade gliomas: from early detection to preventive neuro-oncological surgery. Neurosurg Rev 2015; 39:377-84. [DOI: 10.1007/s10143-015-0675-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/05/2015] [Accepted: 08/09/2015] [Indexed: 10/22/2022]
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19
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Galochkina T, Bratus A, Pérez-García VM. Optimal radiation fractionation for low-grade gliomas: Insights from a mathematical model. Math Biosci 2015; 267:1-9. [PMID: 26113284 DOI: 10.1016/j.mbs.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Abstract
We study optimal radiotherapy fractionations for low-grade glioma using mathematical models. Both space-independent and space-dependent models are studied. Two different optimization criteria have been developed, the first one accounting for the global effect of the tumor mass on the disease symptoms and the second one related to the delay of the malignant transformation of the tumor. The models are studied theoretically and numerically using the method of feasible directions. We have searched for optimal distributions of the daily doses dj in the standard protocol of 30 fractions using both models and the two different optimization criteria. The optimal results found in all cases are minor deviations from the standard protocol and provide only marginal potential gains. Thus, our results support the optimality of current radiation fractionations over the standard 6 week treatment period. This is also in agreement with the observation that minor variations of the fractionation have failed to provide measurable gains in survival or progression free survival, pointing out to a certain optimality of the current approach.
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Affiliation(s)
- Tatiana Galochkina
- Federal Research Clinical Center of Federal Medical & Biological Agency of Russia, 28 Orehovy boulevard, 115682 Moscow, Russian Federation.
| | - Alexander Bratus
- Lomonosov Moscow State University, Faculty of Computational Mathematics and Cybernetics, GSP-1, 1/52, Leninskie Gory, 119991 Moscow, Russian Federation.
| | - Víctor M Pérez-García
- Departamento de Matemáticas, E. T. S. I. Industriales and Instituto de Matemática Aplicada a la Ciencia y la Ingeniería (IMACI), Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain.
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20
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Pérez-García VM, Pérez-Romasanta LA. Extreme protraction for low-grade gliomas: theoretical proof of concept of a novel therapeutical strategy. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2015; 33:253-71. [PMID: 25969501 DOI: 10.1093/imammb/dqv017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 04/15/2015] [Indexed: 01/22/2023]
Abstract
Grade II gliomas are slowly growing primary brain tumours that affect mostly young patients and become fatal after a variable time period. Current clinical handling includes surgery as first-line treatment. Cytotoxic therapies (radiotherapy RT or chemotherapy QT) are used initially only for patients having a bad prognosis. Therapies are administered following the 'maximum dose in minimum time' principle, which is the same schedule used for high-grade brain tumours. Using mathematical models describing the growth of these tumours in response to radiotherapy, we find that an extreme protraction therapeutical strategy, i.e. enlarging substantially the time interval between RT fractions, may lead to better tumour control. Explicit formulas are found providing the optimal spacing between doses in a very good agreement with the simulations of the full 3D mathematical model approximating the tumour spatiotemporal dynamics. This idea, although breaking the well-established paradigm, has biological meaning since, in these slowly growing tumours, it may be more favourable to treat the tumour as the tumour cells leave the quiescent compartment and move into the cell cycle.
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Affiliation(s)
- Víctor M Pérez-García
- Departamento de Matemáticas, Universidad de Castilla-La Mancha, ETSI Industriales, Avda. Camilo José Cela 3, 13071 Ciudad Real, Spain
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21
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Duffau H. The Conceptual Limitation to Relying on Intraoperative Magnetic Resonance Imaging in Glioma Surgery. World Neurosurg 2014; 82:601-3. [DOI: 10.1016/j.wneu.2014.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/11/2014] [Indexed: 12/22/2022]
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22
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Kim Y, Lee HG, Dmitrieva N, Kim J, Kaur B, Friedman A. Choindroitinase ABC I-mediated enhancement of oncolytic virus spread and anti tumor efficacy: a mathematical model. PLoS One 2014; 9:e102499. [PMID: 25047810 PMCID: PMC4105445 DOI: 10.1371/journal.pone.0102499] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/18/2014] [Indexed: 12/23/2022] Open
Abstract
Oncolytic viruses are genetically engineered viruses that are designed to kill cancer cells while doing minimal damage to normal healthy tissue. After being injected into a tumor, they infect cancer cells, multiply inside them, and when a cancer cell is killed they move on to spread and infect other cancer cells. Chondroitinase ABC (Chase-ABC) is a bacterial enzyme that can remove a major glioma ECM component, chondroitin sulfate glycosoamino glycans from proteoglycans without any deleterious effects in vivo. It has been shown that Chase-ABC treatment is able to promote the spread of the viruses, increasing the efficacy of the viral treatment. In this paper we develop a mathematical model to investigate the effect of the Chase-ABC on the treatment of glioma by oncolytic viruses (OV). We show that the model's predictions agree with experimental results for a spherical glioma. We then use the model to test various treatment options in the heterogeneous microenvironment of the brain. The model predicts that separate injections of OV, one into the center of the tumor and another outside the tumor will result in better outcome than if the total injection is outside the tumor. In particular, the injection of the ECM-degrading enzyme (Chase-ABC) on the periphery of the main tumor core need to be administered in an optimal strategy in order to infect and eradicate the infiltrating glioma cells outside the tumor core in addition to proliferative cells in the bulk of tumor core. The model also predicts that the size of tumor satellites and distance between the primary tumor and multifocal/satellite lesions may be an important factor for the efficacy of the viral therapy with Chase treatment.
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Affiliation(s)
- Yangjin Kim
- Department of Mathematics, Ohio State University, Columbus, Ohio, United States of America; Department of Mathematics, Konkuk University, Seoul, Republic of Korea
| | - Hyun Geun Lee
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Nina Dmitrieva
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio, United States of America
| | - Junseok Kim
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Balveen Kaur
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio, United States of America
| | - Avner Friedman
- Department of Mathematics, Ohio State University, Columbus, Ohio, United States of America; Mathematical Biosciences Institute, Ohio State University, Columbus, Ohio, United States of America
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23
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Badoual M, Gerin C, Deroulers C, Grammaticos B, Llitjos JF, Oppenheim C, Varlet P, Pallud J. Oedema-based model for diffuse low-grade gliomas: application to clinical cases under radiotherapy. Cell Prolif 2014; 47:369-80. [PMID: 24947764 DOI: 10.1111/cpr.12114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 03/27/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Diffuse low-grade gliomas are characterized by slow growth. Despite appropriate treatment, they change inexorably into more aggressive forms, jeopardizing the patient's life. Optimizing treatments, for example with the use of mathematical modelling, could help to prevent tumour regrowth and anaplastic transformation. Here, we present a model of the effect of radiotherapy on such tumours. Our objective is to explain observed delay of tumour regrowth following radiotherapy and to predict its duration. MATERIALS AND METHODS We have used a migration-proliferation model complemented by an equation describing appearance and draining of oedema. The model has been applied to clinical data of tumour radius over time, for a population of 28 patients. RESULTS We were able to show that draining of oedema accounts for regrowth delay after radiotherapy and have been able to fit the clinical data in a robust way. The model predicts strong correlation between high proliferation coefficient and low progression-free gain of lifetime, due to radiotherapy among the patients, in agreement with clinical studies. We argue that, with reasonable assumptions, it is possible to predict (precision ~20%) regrowth delay after radiotherapy and the gain of lifetime due to radiotherapy. CONCLUSIONS Our oedema-based model provides an early estimation of individual duration of tumour response to radiotherapy and thus, opens the door to the possibility of personalized medicine.
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Affiliation(s)
- M Badoual
- Laboratoire IMNC, UMR 8165, CNRS, Univ. Paris-Sud, 91405, Orsay, France; Univ Paris Diderot, 75013, Paris, France
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24
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Mandonnet E, de Witt Hamer P, Pallud J, Bauchet L, Whittle I, Duffau H. Silent diffuse low-grade glioma: Toward screening and preventive treatment? Cancer 2014; 120:1758-62. [DOI: 10.1002/cncr.28610] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/16/2013] [Accepted: 12/12/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery; Lariboisiere Hospital; Paris France
- University of Paris 7; Paris France
- Imaging and Modeling Laboratory for Neurobiology and Oncology; Medical Research Unit 8165; Orsay France
| | - Philip de Witt Hamer
- Department of Neurosurgery; VU University Medical Center; Amsterdam the Netherlands
| | - Johan Pallud
- Department of Neurosurgery; Saint-Anne Hospital; Paris France
- University of Paris 5; Paris France
| | - Luc Bauchet
- Department of Neurosurgery; Gui de Chauliac Hospital; Montpellier Medical University Center; Montpellier France
| | - Ian Whittle
- Department of Clinical Neurosciences; University of Edinburgh; Edinburgh United Kingdom
| | - Hugues Duffau
- Department of Neurosurgery; Gui de Chauliac Hospital; Montpellier Medical University Center; Montpellier France
- Institute of Health and Medical Research Unit 1051, Institute of Neuroscience of Montpellier; Montpellier France
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25
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The silent phase of diffuse low-grade gliomas. Is it when we missed the action? Acta Neurochir (Wien) 2013; 155:2237-42. [PMID: 24085316 DOI: 10.1007/s00701-013-1886-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND It is commonly believed that, before being diagnosed after onset of symptoms, diffuse low-grade glioma evolve silently for a long time. The present study aimed to estimate for the first time the exact duration of this silent phase, during which the glioma is radiologically visible but undiscovered. METHODS We retrospectively reviewed our French national database of diffuse low-grade glioma, searching for patients with an MRI-based assessment of their velocity of diameter growth at diagnosis and before any treatment (at least three MRIs over more than 6 months). For each patient, the duration of the silent phase was estimated by the formula: duration = initial diameter / initial velocity of growth. RESULTS A total of 148 patients were included in the study. The mean lead-time duration (i.e., duration of the silent phase) was 14.0 ± 7.8 years (median, 11.6 ; range, 1.6-39.4). The lead-time is statistically not correlated to the tumor volume. It is markedly decreasing with the velocity of diameter expansion. CONCLUSIONS Diffuse low-grade glioma are radiologically detectable but clinically silent for more than a decade. Such a long period of silent evolution could explain our current failure to cure these tumors. It can also be viewed as a window of opportunity to detect these tumors earlier, suggesting the need to set up a screening program.
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26
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Duffau H. The Rationale to Perform Early Resection in Incidental Diffuse Low-Grade Glioma: Toward a “Preventive Surgical Neurooncology”. World Neurosurg 2013; 80:e115-7. [DOI: 10.1016/j.wneu.2012.06.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 12/27/2022]
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27
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Gerin C, Pallud J, Deroulers C, Varlet P, Oppenheim C, Roux FX, Chrétien F, Thomas SR, Grammaticos B, Badoual M. Quantitative characterization of the imaging limits of diffuse low-grade oligodendrogliomas. Neuro Oncol 2013; 15:1379-88. [PMID: 23771168 DOI: 10.1093/neuonc/not072] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Supratentorial diffuse low-grade gliomas in adults extend beyond maximal visible MRI-defined abnormalities, and a gap exists between the imaging signal changes and the actual tumor margins. Direct quantitative comparisons between imaging and histological analyses are lacking to date. However, they are of the utmost importance if one wishes to develop realistic models for diffuse glioma growth. METHODS In this study, we quantitatively compared the cell concentration and the edema fraction from human histological biopsy samples (BSs) performed inside and outside imaging abnormalities during serial imaging-based stereotactic biopsy of diffuse low-grade gliomas. RESULTS The cell concentration was significantly higher in BSs located inside (1189 ± 378 cell/mm(2)) than outside (740 ± 124 cell/mm(2)) MRI-defined abnormalities (P = .0003). The edema fraction was significantly higher in BSs located inside (mean, 45% ± 23%) than outside (mean, 5 %± 9%) MRI-defined abnormalities (P < .0001). At borders of the MRI-defined abnormalities, 20% of the tissue surface area was occupied by edema and only 3% by tumor cells. The cycling cell concentration was significantly higher in BSs located inside (10 ± 12 cell/mm(2)), compared with outside (0.5 ± 0.9 cell/mm(2)), MRI-defined abnormalities (P = .0001). CONCLUSIONS We showed that the margins of T2-weighted signal changes are mainly correlated with the edema fraction. In 62.5% of patients, the cycling tumor cell fraction (defined as the ratio of the cycling tumor cell concentration to the total number of tumor cells) was higher at the limits of the MRI-defined abnormalities than closer to the center of the tumor. In the remaining patients, the cycling tumor cell fraction increased towards the center of the tumor.
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Affiliation(s)
- Chloé Gerin
- Corresponding Author: Mathilde Badoual, Laboratoire IMNC, Campus Universitaire d'Orsay, bat 440, 91405, Orsay, France.
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