2023-11-13 08:02:33
Glioblastoma stem cells migrating from a tumor structure. © Caroline Delmas
Glioblastomas are very aggressive brain tumors whose treatment consists of surgery and radiochemotherapy. A new medical imaging technique might improve patient prognosis, according to a recent clinical trial led by Élisabeth Moyal, professor at Toulouse III – Paul Sabatier University and head of the radiotherapy department at IUCT-Oncopole. The results of its clinical trial carried out at Oncopole and within its Inserm research team at the Toulouse Cancer Research Center (CRCT – Inserm/CNRS/UT3), in collaboration with the neurosurgery department of Toulouse University Hospital, were published in the journal Science Advances November 3rd.
The treatment of glioblastomas consists of surgical resection of the central tumor area (called CE), followed by radiochemotherapy on this same region, as well as on the large peritumoral area infiltrated by the tumor cells which have migrated there (called FLAIR zone). . Despite this treatment, most patients will experience a relapse, particularly in these FLAIR peritumoral regions which were not removed during the initial surgery.
These are the risk areas which were studied by Professor Elisabeth Moyal and her Inserm team. Indeed, using an MRI technique, called magnetic resonance spectroscopy, which makes it possible to analyze the metabolism of tumors, the team had previously shown that CE and peritumoral FLAIR tumor regions displaying hypermetabolism predicted the location where the The tumor would recur following treatment.
Recurrences are mainly attributed to a subpopulation of more aggressive tumor cells, glioblastoma stem cells. The researchers’ hypothesis was therefore that hypermetabolic regions were enriched in this population of cancer stem cells.
To verify this, a clinical trial was set up in 16 patients with glioblastoma, benefiting preoperatively from a classic MRI combined with magnetic resonance spectroscopy allowing biopsies to be taken during surgery guided by these MRI techniques. in CE and FLAIR tumor areas, hypermetabolic or not. Patients were then treated with standard radiochemotherapy.
The experiments carried out at the CRCT by Dr Anthony Lemarié, UT3 lecturer, and Caroline Delmas, laboratory engineer at IUCT and CRCT, confirmed their hypothesis and demonstrated that the hypermetabolic zones in the FLAIR peritumoral regions were enriched in glioblastoma stem cells and overexpressed many genes involved in tumor aggressiveness and resistance. The more patients presented a strong enrichment of glioblastoma stem cells in these hypermetabolic peritumoral areas, the more severe their prognosis for relapse turned out to be.
« The combination of the two imaging techniques MRI and magnetic resonance spectroscopy, before surgery, might allow better resection as well as better therapeutic targeting of hypermetabolic areas present in the peritumoral regions. », Specifies Professor Elisabeth Moyal.
This specific targeting might help improve the prognosis of these very aggressive brain tumors.
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