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ESTRO 36 2017
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F. Sert
1
, S. Hoca
1
, S. Kamer
1
, Y. Anacak
1
1
Ege University Medical School&Hospital, Radiation
Oncology, Izmir, Turkey
Purpose or Objective
Subventricular zone (SVZ) is a paired brain structure
situated throughout the lateral walls of the lateral
ventricles, a known site of neurogenesis and self-renewing
neurons in the adult brain. Some current theories propose
that brain tumour stem cells originating from
subventricular zone (SVZ) play a role in progression of
high-grade gliomas. Since almost all glioblastomas
progress locally despite aggressive surgery and
radiotherapy, recur within the high-dose irradiation
volume in most cases, the theory of tumor cell migration
from SVZ is interesting to explore. Irradiation of SVZ
supposed to kill brain tumor stem cells which may alter
tumour progression and survival. The purpose of this study
is to evaluate the impact of the radiation dose to SVZ on
progression rates and overall survival in glioblastoma.
Material and Methods
Study population consisted of 80 glioblastoma patients (23
females, 57 males) with a median age of 55.5 (21-75) who
were treated from January 2012 to December 2014. All
patients underwent surgery followed by adjuvant
radiotherapy (60 Gy/30 fractions) and concomitant /
adjuvant temozolomid. Bilateral SVZ were contoured on
MRI images and registered to planning CT slices. Target
volumes and organs at risk were also contoured.
Conformal radiotherapy with 3-4 fields or IMRT with 1-2
volumetric arcs were used for planning. Median doses for
ipsilateral, contralateral and bilateral SVZ were recorded
and relations with progression and survival were analyzed
using two threshold values at 40 Gy and 50 Gy. Analyses
were performed after a median follow-up of 13 months.
Results
Median progression free survival (PFS) was 10 months (2-
36) and overall survival (OS) was 12 months (3-48). The
unfavorable prognostic factors affecting PFS were tumor
extending to ventricles (p<0.01), ipsilateral SVZ doses >50
Gy (p<0.05), and contralateral SVZ doses >50 Gy (p<0.05).
The unfavorable prognostic factors affecting OS were
tumor extending to ventricles (p<0.001), contralateral SVZ
doses >40 Gy (p<0.05) and bilateral SVZ doses >40 Gy
(p<0.05). In multivariate analysis of prognostic factors,
tumor extending to ventricles was the only unfavorable
factor for both PFS (p<0.001) and OS (p<0.001).
Conclusion
PFS and OS were shorter in the patients in whom tumor
was extending to ventricles and in those where SVZ
received at least 40-50 Gy. The data of this study is
supports the previous studies showing an inverse
correlation between irradiation of SVZ and prognosis. With
the present data we can only speculate that those tumors
extending deep into the lateral ventricles likely to be
larger in size, closer to nearby sensitive structures, and
not amenable to total resection. Radiation volumes should
cover some parts of SVZ and lateral ventricles to give the
prescribed dose to in those unfavorable tumors, which
may explain the inverse correlation with SVZ irradiation
and survival. Further research is required to clarify the
role of brain tumor stem cells locates at SVZ in the
prognosis of high-grade gliomas.
PO-0635 Can psychological support during RT improve
distress, mood or quality of life in CNS tumor patients?
L. Dinapoli
1
, S. Chiesa
1
, N. Dinapoli
1
, F. Beghella Bartoli
1
,
S. Bracci
1
, M. Massaccesi
1
, A. Tenore
1
, A. Pesce
1
, V.
Valentini
1
, M. Balducci
1
1
UCSC, Radiation Oncology Department Gemelli-ART,
Roma, Italy
Purpose or Objective
Patients with CNS tumor often show at diagnosis
significant levels of distress, anxiety and depression,
which may increase during radiotherapy (RT), for side
effects (headache, hair loss, cognitive deficits) or
psychological impact on everyday life (absence from work,
caregivers’ burden). These factors could influence
negatively patients’ quality of life (QoL) during the entire
RT course. The objective of this study is to evaluate the
effect of a psychological support offered to patients
throughout RT on distress, anxiety, depression and QoL.
Material and Methods
Consecutive patients with CNS tumors who underwent RT
with radical intent were included between January and
September 2016. Psychological support was available for
all patients. Distress Thermometer (DT), Hospital Anxiety
and Depression Scale (HADS) and Functional Assessment of
Cancer Therapy (FACT)-Br were used to evaluate
emotional distress, mood and QoL, respectively. The tests
were self-administered at the beginning (T0), the middle
(T1), the end (T2) of the RT course and three months after
the end of RT (T3). Statistical analysis of tests’ scores was
performed by means of Wilcoxon test for paired samples.
Results
Twenty-eight patients (12 male and 16 female, median
age 56, range 20-72 years) who underwent radical RT for
CNS tumors were included. Radiotherapy was post-
operative in all patients and was delivered up to a median
total dose of 60 (range 50-66) Gy. Twenty (71.4%) patients
received concurrent chemotherapy with temozolomide.
All 28 patients underwent the T0, T1 and T2 evaluation.
Data collection after three months (T3) is still ongoing.
At T0, 17/28 patients (60.7%) were emotionally distressed
(DT score≥4, DT median score=7); at T1, 20/28 (71.4%)
patients had significant emotional distress and at T2,
16/28 (57.1%) patients had significant emotional distress.
At T0, 9/28 patients (32.1%) showed anxiety/depression
(HADS score≥14, HADS median score=20); at T1, 11/28
(39.3%) and at T2, 6/28 (21.4%) patients had significant
anxiety and depression.
During RT, in patients who were distressed at baseline
(17/28), DT score significantly improved at T2 (median DT
score 7 and 5, at T0 and T2 respectively, p<0.05)(fig 1).
In patients who were anxious and depressed at baseline
(9/28), HADS score did not significantly change during RT.
Regarding QoL, statistical analysis on FACT-Br (T0 Vs T2)
showed stable scores in Social, Functional, Physical and
Symptoms subscales and an improvement in Emotional
Well-Being subscale (median Emotional Well-Being score
18 and 19, at T0 and T2 respectively, p=0.002).