title: Irradiating the Subventricular Zone in Glioblastoma Patients: Is there a Case for a Clinical Trial?
abstract: Glioblastoma is the most common and aggressive adult brain tumour. Over the last 10 years it has emerged that the subventricular zone (SVZ), the largest adult neural stem cell niche, has an important role in the disease. Converging evidence has implicated transformation of adult neural stems in gliomagenesis and the permissive stem cell niche in disease recurrence. Concurrently, clinical studies have suggested that SVZ involvement is a negative prognostic marker. It would follow that irradiating the SVZ may improve outcomes in glioblastoma by directly targeting this putative sanctuary site. To investigate this potential strategy, 11 retrospective studies and 1 prospective study examined the relationship between dose to the SVZ and survival outcomes in glioblastoma patients. This review summarises the theoretical underpinning of this strategy, provides a critical evaluation of the existing evidence and discusses the rationale for a clinical trial.
authors.affiliation: John van Geest Centre for Repair, Cambridge, UK; University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: B
authors.initials: B
authors.lastname: Nourallah
authors.affiliation: University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: R
authors.initials: R
authors.lastname: Digpal
authors.affiliation: University of Cambridge, Department of Oncology, Addenbrokes Hospital, Cambridge, UK.
authors.forename: R
authors.initials: R
authors.lastname: Jena
authors.affiliation: John van Geest Centre for Repair, Cambridge, UK; Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrookes Hospital, Cambridge, UK. Electronic address: cw209@cam.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Watts
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy*; D005909:Glioblastoma / Q000532:radiotherapy*; D006801:Humans; D020547:Lateral Ventricles / Q000528:radiation effects*; D008297:Male; D014411:Neoplastic Stem Cells / Q000528:radiation effects; D055153:Stem Cell Niche / Q000528:radiation effects
keywords: Cancer stem cells; glioblastoma; neural stem cells; radiotherapy; subventricular zone