Andreas[a]
Neurosurg 2002 Dec;97(5 Suppl):627-30
Morphological redifferentiation in a malignant astrocytic tumor after gamma knife radiosurgery.
Szeifert GT, Massager N, Brotchi J, Levivier M.
Centre Gamma Knife, Hopital Academique Erasme, Universite Libre de Bruxelles, Brussels, Belgium.
OBJECT:
The purpose of this study was to demonstrate positron emission tomography (PET), histological, and immunohistochemical data
supporting the notion of morphological redifferentiation in a malignant astrocytic tumor after gamma knife radiosurgery (GKS).
METHODS:
The 11C- methionine-PET activity, Ki-67 labeling index (LI), and p53 protein expression were examined using immunohistochemical
methods to assess tumor proliferative capacity. Tissue samples were obtained before and after radiosurgery in a patient with a malignant
(Grade III) cerebellar astrocytoma. Positron emission tomography scans obtained 5.5 months following radiosurgery were suggestive of
decreased tumor proliferative capacity and radionecrosis. Histological examination of tumor tissue removed 42 months before GKS was
characteristic of a diffuse Grade III astrocytoma in every part of the resected tumor. Similar material removed 6 months after GKS was
consistent with a Grade II astrocytoma in the great majority of the resected tumor.
CONCLUSIONS:
Histopathological examination
showed positive phenotypic modification (redifferentiation) consistent with a Grade 11 astrocytoma in the majority of tumor specimens after
radiosurgery. After GKS both the Ki-67 LI and p53 reaction decreased considerably as did 11C methionine uptake. Because p53 is one of
the essential genes involved in the radiation response, mutations induced by the ionizing effect of gamma rays might promote partial repair
of this gene´s tumor suppressor function.