Original ArticleSurvival of Ventricular and Periventricular High-Grade Gliomas: A Surveillance, Epidemiology, and End Results Program–Based Study
Introduction
Intracranial gliomas are neuroepithelial tumors hypothesized to originate from neoplastic transformation of glial cells.1 High-grade glioma (HGG, or malignant glioma) is the most common brain glioma with an extremely malignant clinical course, with an annual incidence of 5 per 100,000, and constituting 70% of all brain gliomas.2, 3 According to the literature, the estimated median survival is 9–12 months for glioblastomas (GBMs) and 2 to 5 years for grade 3 anaplastic tumors.1, 2 although this has improves over the last decade owing to continuing optimization of treatment regimens and evolution of targets and delivery modalities in chemotherapy.4, 5, 6
Ventricular or periventricular HGGs typically involve the ventricular zone or subventricular zone (V-SVZ), and represent a special subcohort of HGGs with unique features. The V-SVZ is known to harbor neural stem cells of a multipotent nature, which increases the propensity to generate aggressively proliferating tumors.1, 7, 8, 9, 10 Indeed, in multiple studies, this location alone has been shown to significantly predict worse survival in patients with malignant gliomas.9, 10, 11, 12, 13 Management challenges arise when the poor prognosis of V-SVZ malignant gliomas is weighed against the increased surgical complexity and associated complications, owing to the deep location and risk for metastasis with opening of ventricles.7, 14 Although chemoradiation is considered the standard therapy for HGGs,15 controversy remains regarding the extent of resection and aggressiveness of postresection radiation therapy (RT) when the V-SVZ is involved (especially when ventricles are opened). Some authors have suggested aggressive resection without modification of post-treatment RT, whereas others have favored a more conservative surgical approach due to fear of leptomeningeal spread (LMS),16, 17 or a more aggressive RT protocol for survival benefit.6
A survival analysis for elucidation of survival and risk factors has yet to be performed in a population-based study. In the present study, we used the Surveillance, Epidemiology, and End Results Program (SEER) database to investigate and quantify the impact on survival of the extent of surgical resection and RT on a population-based scale.
Section snippets
Study Design and Patient Cohort Selection
This study was designed as an observational longitudinal survival study. Institutional Review Board approval was not required because we used publicly available data from the SEER database, which is administered by the National Cancer Institute, with patient data collected prospectively in 18 states. The data source was the SEER submission in 2015 which included a patient cohort covering the years 1973–2013. Patients with malignant brain tumors with location labeled as “ventricles” were first
Study Cohort and Histology
A total of 2009 patients with malignant ventricular or periventricular tumors were identified in the SEER database. After application of exclusion criteria, our cohort comprised 353 patients with high-grade V-SVZ gliomas. The patient selection process is illustrated in Figure E1, and included tumor histology is described in Table 1. As shown, the most prevalent histology in our cohort was glioblastoma (glioblastoma NOS plus giant cell glioblastoma; 48.7%), followed by anaplastic ependymoma
Summary of Key Results
Here we present the prognosis and factors predictive of survival in patients with ventricular or periventricular HGGs from a population-based perspective. To our knowledge, our series represents the largest cohort with this unique combination reported to date. We found that the HGGs in this location consist mainly of glioblastomas, followed by grade III anaplastic gliomas. Even with both grade III and grade IV gliomas, however, the overall median survival of the patients with V-SVZ HGGs was 12
Conclusions
In agreement with previous studies, we found better survival in younger patients with ventricular or periventricular HGGs compared with older patients; however, no tumor-related characteristics were predictive of survival. The management of ventricular or periventricular HGGs remains challenging and requires rigorous refinement of treatment regimens, especially regarding EOR. In this study, we found no evidence to support aggressive surgical resection, although postoperative RT was of
References (29)
- et al.
The impact of adjuvant radiation therapy for high-grade gliomas by histology in the United States population
Int J Radiat Oncol Biol Phys
(2014) - et al.
Increased subventricular zone radiation dose correlates with survival in glioblastoma patients after gross total resection
Int J Radiat Oncol Biol Phys
(2013) - et al.
Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease
Blood
(2002) - et al.
Association of MRI-classified subventricular regions with survival outcomes in patients with anaplastic glioma
Clin Radiol
(2017) - et al.
Intraventricular glioblastomas
World Neurosurg
(2016) - et al.
Minimally invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: multicentric experience and results
World Neurosurg
(2016) - et al.
Neural stem cells and the origin of gliomas
N Engl J Med
(2005) - et al.
Malignant gliomas in adults
N Engl J Med
(2008) - et al.
The 2007 WHO Classification of Tumours of the Central Nervous System
Acta Neuropathol
(2007) - et al.
Updates in the management of high-grade glioma
J Neurol
(2014)
The human brain subventricular zone: stem cells in this niche and its organization
Neurosurg Clin N Am
Glioblastoma multiforme and adult neurogenesis in the ventricular-subventricular zone: a review
J Cell Physiol
Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults
J Neurosurg
Relationship of glioblastoma multiforme to the lateral ventricles predicts survival following tumor resection
J Neurooncol
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2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :To date, despite all the advances in proteomics, and the results of the available literature suggesting a possible role of SVZ in the survival of GB patients [6,7], a huge void in the full understanding of a possible role of these proteins in the survival of the patients is still present. The aforementioned findings [2,3,6,7,14,17], brought several investigators to the promising hypothesis that irradiating the SVZ may extend survival in GB [16]. Current evidence is unfortunately still limited by incomplete study designs and inconsistent survival outcomes, the absence of an undisputed “effective dose” and even an undisputed definition of “SVZ area”.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Wuyang Yang and Tao Xu contributed equally to this work.