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. 2013 Jan;8(1):9-14.
doi: 10.4103/1793-5482.110274.

Protective effect on normal brain tissue during a combinational therapy of 2-deoxy-d-glucose and hypofractionated irradiation in malignant gliomas

Neelam K Venkataramanaa  1 , P K Venkatesh, B S Dwarakanath, S Vani
Affiliations

Protective effect on normal brain tissue during a combinational therapy of 2-deoxy-d-glucose and hypofractionated irradiation in malignant gliomas

Neelam K Venkataramanaa et al. Asian J Neurosurg. 2013 Jan.

Abstract

Purpose: To investigate the effect of 2-deoxy-D-glucose (2-DG), an inhibitor of glucose transport and glycolysis, on glioblastoma and the normal brain tissue during combined treatment with hypofractionated radiotherapy.

Materials and methods: Twenty patients with malignant gliomas (18 Glioblastoma Multiformae, 2 Anasplastic Astrocytoma grade III) following surgery were treated weekly (once) with 2-DG, (250 mg/kg body weight), followed by 5 Gy of radiation to the tumor bed per fraction for 7 weeks. Clinical evaluation, complete hemogram, and random blood sugar levels were carried out in each cycle. Follow-up computed tomography (CT)/magnetic resonance imaging (MRI) was done to evaluate radiation-induced changes. Kernofsky Performance scale (KPS) was recorded preoperatively; postoperatively, and post-therapy till the last follow-up.

Results: Twenty patients were recruited for this trail; 19 of them completed the treatment and 1 discontinued. The survival period ranged between 6 and 36 months after the treatment, with a median survival of 14 months. CT and MRI revealed significant tumor necrosis. Histological evidence from the tissue during reexploration confirms the hypothesis of protective effect of 2-DG on normal brain. KPS was above 80% in majority of the patients, 6 months after the surgery.

Conclusion: Radiotherapy coupled with 2-DG enhances tumor necrosis selectively and significantly while the normal brain gets relatively protected. This has been reflected in our study both clinically by preservation of quality-of-life and pathologically by retaining the integrity of normal brain architecture.

Keywords: 2-deoxy-D-glucose; malignant gliomas; neural protection; quality-of-life; radionecrosis; radiotherapy.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Pre-operative image; (b) Post-operative image
Figure 2
Figure 2
(a) Pre-operative image; (b) Post-operative image; (c) Radiotherapy planning {Tumor and 3 cm around the tumor}; (d) Follow up after 3 months
Figure 3
Figure 3
(a) Severe tumor necrosis with 2-DG+RT (H & E); (b) Tumor necrosis with conventional RT and with 2-DG+RT
Figure 4
Figure 4
Thickened blood vessel and hyaline formation with 2-DG+RT
Figure 5
Figure 5
Presence of giant cells following 2-DG+RT therapy
Figure 6
Figure 6
Gliomesenchymal scar demarking the parenchyma after 2-DG+RT
Figure 7
Figure 7
Preserved choroid plexus in 2-DG+RT
See this image and copyright information in PMC

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