Abstract
Stereotactic radiosurgery is an encouraging approach to deliver higher doses of radiation boost for malignant gliomas safely and precisely. The purpose of this study was to investigate the radiation response and histological changes of malignant astrocytic tumors after stereotactic linac radiosurgery (SLRS). We studied an autopsy case of recurrent glioblastoma multiforme (GBM) and two surgical cases with gross total removal of recurrent GBM and anaplastic astrocytoma transformed from fibrillary astrocytoma treated with SLRS. Destructive changes, such as the disappearance of viable cells, coagulation necrosis, and fibrinoid degeneration of vascular walls, were observed in the center of the target of SLRS, which showed histologically similar radiobiological reactions to well-known delayed central nervous system radiation necrosis caused by conventional radiotherapy. The region showing such radiation necrosis was within the area irradiated with approximately 15–20Gy or more by SLRS; however, dense viable tumor cells remained in the periphery that was irradiated with less than 15 Gy. In a comparative immunohistochemical study of the tumors before and after SLRS, neither MIB-1 and p53 labeling indices nor immunoreactivity for GFAP represented any persistent tendencies. There were very few TUNEL-positive cells in either tumor before and after SLRS. These results showed that radiosurgery for malignant gliomas leads to earlier radiation necrosis than conventional radiation and that it is useful in eradicating tumor cells in the center of the target. However, some viable tumor cells may remain in the periphery irradiated with an insufficient dose for cell death and may be partly transformed in character by DNA damage due to radiation. Proton magnetic resonance spectroscopy (MRS) was suggested to characterize the radiation response in radiosurgery tumor targets for correlation with histological findings.
Similar content being viewed by others
References
Walker MD, Strike TA, Sheline GE (1979) An analysis of dose-effect relationship in radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5:1725–1731
Wara WM, Bauman GS, Sneed PK, et al (1988) Brain, brain stem and cerebellum. In: Perez CA, Brady LW (eds) Principles and practice of radiation oncology, 3nd edn. Lippincott-Raven, Philadelphia, pp 777–828
Cardinale RM, Schmidt-Ullrich RK, Benedict SH, et al (1998) Accelerated radiotherapy regimen for malignant gliomas using stereotactic concomitant boosts for dose escalation. Radiat Oncol Investig 6:175–181
van Kampen M, Engenhart-Cabillic R, Debus J, et al (1998) Radiochirurgie des Glioblastoma multiforme in der Rezidivsituation. Heidelberger Erfahrungen im Literaturvergleich. Strahlenther Onkol 174:19–24
van Kampen M, Engenhart-Cabillic R, Debus J, et al (1998) Stellenwert der Radiochirurgie in der Primärtherapie des Glioblastoma multiforme. Heidelberger Erfahrungen im Literaturvergleich. Strahlenther Onkol 174:187–192
Shrieve DC, Alexander E, Black PM, et al (1999) Treatment of patients with primary glioblastoma multiforme with standard post-operative radiotherapy and radiosurgical boost: prognostic factors and long-term outcome. J Neurosurg 90:72–77
Cho KH, Hall WA, Gerbi BJ, et al (1999) Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 45:1133–1141
Hudes RS, Corn BW, Werner-Wasik M, et al (1999) A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys 43:293–298
Lederman G, Wronski M, Arbit E, et al (2000) Treatment of recurrent glioblastoma multiforme using fractionated stereotactic radiosurgery and concurrent paclitaxel. Am J Clin Oncol 23:155–159
Nwokedi EC, DiBiase SJ, Jabbour S, et al (2002) Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 50:41–47
Shinoda J, Yano H, Okumura A, et al (2002) Stereotactic linac radiosurgery for patients with glioblastoma multiforme. A preliminary report (in Japanese). Neuro-Oncology (Tokyo) (in press)
Kodera T, Kubota T, Kabuto M, et al (2000) Analysis of the proliferative potential of tumor cells after stereotactic radiosurgery for recurrent astrocytic tumors. Neurol Res 22:802–808
Uematsu Y, Fujita K, Tanaka Y, et al (2001) Gamma knife radiosurgery for neuroepithelial tumors: radiological and histological changes. Neuropathology 21:298–306
Gavrieli Y, Sherman Y, Ben-Sasson SA (1992) Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation. J Cell Biol 119:493–501
Buatti JM, Friedman WA, Bova FJ, et al (1995) Linac radiosurgery for high-grade gliomas: the University of Florida experience. Int J Radiat Oncol Biol Phys 32:205–210
Loeffler JS, Shrieve DC, Alexander E III (1994) Radiosurgery for glioblastoma multiforme: the importance of selection criteria. Int J Radiat Oncol Biol Phys 30:731–733
Alexander E III, Loeffler JS (1998) Radiosurgery for primary malignant brain tumors. Semin Surg Oncol 14:43–52
Alexander E III, Loeffler JS (1999) The role of radiosurgery for glial neoplasms. Neurosurg Clin N Am 10:351–358
Graves EE, Nelson SJ, Vigneron DB, et al (2000) A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 46:319–328
Graves EE, Nelson SJ, Vigneron DB, et al (2001) Serial proton MR spectroscopic imaging of recurrent malignant gliomas after gamma knife radiosurgery. Am J Neuroradiol 22:613–624
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shinoda, J., Yano, H., Ando, H. et al. Radiological response and histological changes in malignant astrocytic tumors after stereotactic radiosurgery. Brain Tumor Pathol 19, 83–92 (2002). https://doi.org/10.1007/BF02478932
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02478932