Abstract
It is conventional strategy to treat highly malignant brain tumors initially with cytoreductive surgery followed by adjuvant radio- and chemotherapy. However, in spite of all such efforts, the patients' prognosis remains dismal since residual glioma cells continue to infiltrate adjacent parenchyma and the tumors almost always recur. On the basis of a simple biomechanical conjecture that we have introduced previously, we argue here that by affecting the 'volume-pressure' relationship and minimizing surface tension of the remaining tumor cells, gross total resection may have an inductive effect on the invasiveness of the tumor cells left behind. Potential implications for treatment strategies are discussed.
Highlights
Malignant brain tumors such as gliomas expand through proliferation and invasion within the confines of the bony skull, in a mechanically constraint area
The brain tissue's mechanical 'reserve' rooms, i.e. the interstitial space, the cerebrospinal fluid filled ventricles and the vascular system can only temporarily compensate, through fluid shifts, any sudden or even gradual increase in intracranial pressure (ICP) as it relates to e.g. an intracerebral hemorrhage or a tumor
Standard treatment for highly aggressive gliomas (anaplastic astrocytomas and glioblastomas (GBM)) has changed little over the years and still consists of gross surgical resection followed by adjuvant radiotherapy and chemotherapy (e.g., [2])
Summary
Malignant brain tumors such as gliomas expand through proliferation and invasion within the confines of the bony skull, in a mechanically constraint area. Once the point of decompensation is reached (Figure 1) any even miniscule increase in volume will trigger a massive, life-threatening increase in ICP [1] that generally leads to surgical intervention in an attempt to resect some of this pressure-raising volume.
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