J. Biomedical Science and Engineering, 2010, 3, 501508 JBiSE doi: 10.4236/jbise.2010.35070 Published Online May 2010 (http://www.SciRP.org/journal/jbise/). Published Online May 2010 in SciRes. http://www.scirp.org/journal/jbise Diffusive modelling of glioma evolution: a review Alexandros Roniotis1,2, Kostas Marias1, Vangelis Sakkalis1, Michalis Zervakis2 1Foundation for Research and TechnologyHellas, Institute of Computer Science, Heraklion, Greece; 2Technical University of Crete, Department of Electronic and Computer Engineering, Chania, Greece. Email: {roniotis, kmarias, sakkalis}@ics.forth.gr; michalis@display.tuc.gr Received 26 January 2010; revised 27 January 2010; accepted 24 February 2010. ABSTRACT Gliomas, the most aggressive form of brain cancer, are known for their widespread invasion into the tis sue near the tumor lesion. Exponential models, which have been widely used in other types of cancers, can not be used for the simulation of tumor growth, due to the diffusive behavior of glioma. Diffusive models that have been proposed in the last two decades seem to better approximate the expansion of gliomas. This paper covers the history of glioma diffusive model ling, starting from the simplified initial model in 90s and describing how this have been enriched to take into account heterogenous brain tissue, anisotropic migration of glioma cells and adjustable proliferation rates. Especially, adjustable proliferation rates are very important for modelling therapy plans and per sonalising therapy to different patients. Keywords: Glioma; Brain Tumor; Diffusive Models; Proliferation; Invasion 1. INTRODUCTION Glioma is a type of cancer of central nervous system that starts in the brain or in the spine. It is called a glioma because it arises from glial cells. The most common site of gliomas is the brain. Gliomas constitute more than 50% of all brain cancer cases. Despite extended research in this area, patients are rarely given more than 12 months survival time [1]. The diagnosis of gliomas can be done by MRI, CT, angiogram or biopsy, with MRI being the most common method. After glioma is diagnosed, treatment is directly necessary. However, the most important problem with diagnosis and treatment is that gliomas are characterized by invasiveness. This means that there are cells diffused beyond the imaged tumor, which cannot be visualized by common imaging techniques. Thus, even if the clinician allows some safety margin during resection around the imaged tumor, cancer is expected to recur. These dispiriting results have forced researchers worldwide to work with understanding the glioma grow th procedure and its special pathology. One of the rapid ly emerging fields in glioma study is tumour growth modeling; researchers have been working on finding mathematical models that efficiently describe the glioma growth procedure. 1.1. Mathematical Modelling A mathematical model uses mathematical language to describe a system. In the case of glioma, a mathematical description of how glioma grows is under research. At first someone has to bear in mind the basic features that any typical mathematical model in biology must possess [2]. These are schematically described in Figure 1. Firstly, the model should be initiated within a realistic biological state. Additionally, the modeled biological processes should be understood and discretized as much as possibly, meaning that steps and real biological para meters should be isolated. Continuing, it is essential to allocate a mechanism that could simulate these steps and incorporates these parameters. Specifically, this me chanism could be described by an equation. Going fur ther, the next step is to study the model mathematically and come up with solutions that include realistic boun dary and initial conditions. Lastly, after having acquired the theoretical results it is of great importance to go back in biological process with predictions, comments and suggestions for experiments that will either ascertain or disprove the developed model. At this level, model suc cess is highly dependent on combining experimentation and theory together. Because, even if the experimental results indicate that the model is incorrect, this is the right way to reach a successful conclusion. In final con sideration, mathematics is very important in biology, however, they must be treated with seriousness. If ma thematics is used for solving any biological process, without thoroughly studying the biological background, it is very possible to come up with solutions that not only do not contribute to corroborated conclusions, but also do harm. As stated in [2], the theoretical literature abounds with many such articles. Recently, with the explosion of biological sequence data, many biological sequence databases have redun
502 A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 Copyright © 2010 SciRes. JBiSE dant sequences which can cause problems for data anal ysis. These redundant sequences cannot provide valuable information for analysis but detracts from the statistical significance of interesting hits. Moreover, processing these redundant sequences often requires more time and computational resources. Removing redundant sequen ces is undoubtedly very helpful for performing statistical analysis and accelerating extensive database searching [1]. And it is also a way to obtain the real protein fami lies and their representatives from a large sequences da taset. Therefore, it is necessary to develop an appropriate algorithm to remove redundant sequences from a bio logical sequence database. Hobohm and Sander’s algorithm is a widely used al gorithm in many redundant sequence removing pro grams. Hobohm and Sander’s algorithm was firstly in troduced by U. Hobohm et al. of EMBL laboratory in 1992. In 1998, Lissa Holm and Chris Sander developed a program based on this algorithm to generate a non redundant protein database NRDB90 [2]. After that, oth er researchers developed some programs for removing redundant sequences on the basis of Hobohm and Sand er’s algorithm, such as CDHIT and PISCES. A lot of research is currently taking place in mathe matically modeling the glioma growth procedure. An efficient mathematical model for gliomas could help researchers and clinicians to get a better understanding of tumour growth pathology. They could also to predict the aggressiveness of a patient’s tumour and, thus, to better define the margins of a tumour, so as to use them Figure 1. Mathematical modeling for a general biological process. when applying resection or radiotherapy. Moreover, by importing therapy parameters into the model, the clini cian can predict which therapy scheme is expected to yield better results for the patient. 1.2. General Cancer Modelling Studying tumour expansion and simulating this accord ing to mathematical models, has been an area of studies in cancer since late 90s’ [35]. Tumour growth has been studied by a series of models. The first models focused on tumour behavior in time. More specifically, the first proposed temporal models were based on either expo nential, logistic or Gompertz laws [6]. As expected, these models were followed by spatial growth models in later years. Thus, one such deterministic model has been used to simulate cancer growth as a wave phenomenon, taking into account mitosis and nutritient depletion [7]. Moreover, deterministic models taking into account im mune response [8] or mitotic rates changes [9] have been proposed. The research efforts for applying these models in in filtrative cancers, such as glioma, failed because cell motility hadn’t been included in the model. Thus, some stochastic and cellular automata have been introduced for glioma simulation, taking into account cell cycle, lack or abundance of nutritional elements in the sur rounding area of cells and therapeutic regimen [10]. However, the mostly used models for the glioma case are the diffusive models that simulate the spatiotemporal change of glioma cell density, using partial differential equations. The combination of biomechanics and diffu sive models is one of the latest advances in glioma mod eling, for combining diffusion glioma cells and dis placement of tissue caused by glioma growth [11]. 2. THE DIFFUSION REACTION MODEL Unlike solid tumors, for which simple exponential or geometric expansion represents expansion of tumor vo lume, the glioma growth rate cannot be determined as the classical doubling rate [12], because gliomas can migrate and proliferate. In order to simulate glioma ex pansion, scientists have proposed the application of the diffusionreaction equation, which is currently mostly used. The first that proposed a diffusive model for gli oma growth was Murray in 1989 [13]. Murray derived the equation by exploiting the mass balance equation, by imagining cells as internal sources for producing the diffused cells. Murray proposed the diffusionreaction formalism as: (,) (,)+(,)((,)) (,) (1) where
A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 503 Copyright © 2010 SciRes. JBiSE (,) denotes the glioma cell concentration in posi tion at time . (,) is the diffusion flux of cell that follows Flick’s law (i.e. = where and div are the gradient and divergence operators respectively). () denotes the source factor, representing the gli oma cell reproduction. () denotes the treatment factor, representing the glioma cell loss due to treatment. This is zero, when no treatment is applied. The initial state of the model, (, 0), is defined as the initial distribution of cancerous cells. () ()() is the net proliferation rate. This equation was the basis of the later most impor tant works for glioma modeling. The general procedure for glioma modelling, as derived by Murray’s diffusive model, is presented in Figure 2. The solution of the diffusionreaction equation requires the application of numerical schemes, since there is no direct formula of its solution. The solution has to be ap proximated iteratively till time point of interest is reached. 2.1. Net Proliferation Rates for untreated gliomas In 1995, Tracqui studied the evolution of cell concen Figure 2. Generalised mathematical modeling of glioma growth. tration, by using two characteristic of tumour growth: proliferation and invasion [3]. Tracqui proposed that the cells proliferate at exponential rate ρ, i.e. : ()= (2) So, Tracqui changed Equation 1, to ()+ (3) where ρ denotes the proliferation rate of cells. Other proposed models [14], instead of geometrical rate, used either Verhulst law ()= (4) or Gompertz law ()=ln (5) where is the maximum value that concentration can reach. Eq.2 has been mainly used for simulating un treated gliomas. 2.2. First Estimation of and From the very beginning of diffusive models, one of the key issues was the estimation of parameters that are be ing used. The diffusion coefficient and the prolifera tion rate are the basic parameters for the diffusive models. The first estimation of them is places in 1995 [1], when Silbergeld studied biological data and intro duced two groups of glioma cells: the common ones and the resistanttofi rst chemotherapy ones. Parameter D was firstly defined either at =/, with the percentage of cells resistant to chemotherapy being at 8%, or at =/ without resistant cells, whi le ρ was defined at =/. 2.3. Resection Modeling Getting this further, one of the next steps was to the model cancer evolution after ectomy [3,15]. This was firstly simulated in 1993 by setting the concentration of the ectomized area equal to zero and, then, allowing the surrounding malignant cells proliferate and diffuse until the sphere reaches 6cm diameter. An example of ectomy, reproduced from [3], is given in Figure 3. 2.4. Low Grade Gliomas Up to 1996, diffusive models studied highgrade gliomas due to their remarkably fast invasion. However, studying lowgrade gliomas was important as well. Hence, in 1996, Woodward [16] suggested that speed of growth in lowgrade tumours should be 10% of the respective one in highgrade gliomas, yielding satisfactory results. After some years, in 2003, Mandonnet [17] proposed that lowgrade gliomas grew slowly, but linearly. This is mathematically derivable by Eq.3, because the expand ing velocity of a population, which follows only the dif fusion and growth laws of (3), can be calculated as
504 A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 Copyright © 2010 SciRes. JBiSE 2. Mandonnet et al. used clinical data reproduced from 27 patients to estimate that the average tumour velocity was 2 mm per year. 2.5. Brain Heterogeneity Up to 2000, researchers didn’t take brain anatomy into account. However, taking into account brain matter is of foremost importance, since it was observed that migra tion in white brain tissue is faster than in grey tissue [4]. Thus, modeling of gliomas should take brain hetero geneity into account. Indeed, in 2000, Swanson inno vated by introducing the problem and incorporating white and gray matter differentiation in the diffusion coefficient of Eq.3. More specifically, the equation continued to hold, but for variable , i.e. : (())+ (6) Diffusion coefficient varies according to position, with D(x) = or , i.e. being constant for in grey and white brain tissue respectively. Moreover, in order Swanson to apply the model, an brain atlas was required providing all the information about white and grey matter areas. Indeed, BrainWeb database [18] was available for extracting this information. An example of Swanson’s simulation, reproduced from [4], is given in Figure 4. 2.6. Anisotropic Cell Migration In 2005, Jbabdi et al. [19] introduced brain tissue aniso tropy in diffusive modeling. As observed, glioma cell migration is facilitated along the directions of white matter fibers [2021]. This observation can be supported by the diffusion tensor Magnetic Resonance imaging (DT MRI) that gives a very good 3D reconstruction of white matter fibers. Jbabdi defined Eq.7 , as (())+ (7) where is the diffusion tensor that describes cell dif fusion rate at point , i.e. a 3 × 3 symmetric positive definite matrix that reflects local anisotropy. 2.7. Biomechanical Deformation In 2005, Clatz et al. from INRIA [11] developed a model that simulates Jbadbi’s model, but taking also into ac count the biomechanical deformations that occurs in brain due to tumour expansion. This model uses a pre dictor of the mass effect induced by both the tumor pro liferation and infiltration. Figure 5 shows an example of a simulation with Clatz’s model, with the deformation of tissues presented. The image is reproduced from [11]. Figure 3. (Reproduced from [3])tracqui’s simulation of a tumour resection. The parameter values of the model are = 0.012 /day, = 107 cm2/s. (a) (b) (c) (d) Figure 4. (Reproduced from [4]) Simulation of tumour invasion of a highgrade glioma in the superior cerebral hemisphere using Swanson’s model: (a) (b) at diagnosis; (c) (d) at death; (a) (c) as seen by Swanson’s standard threshold of detection; (b) (d) as calculated out to 1.25% of the threshold (boundary) cell concentration defining the sensitive threshold of detection.
A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 505 Copyright © 2010 SciRes. JBiSE Figure 5. (Reproduced from [11])Simulation of displacement of the tissues induced by the tumor mass effect, us ing Clatz’s model. 3. Parameter estimation in modern models According to [22], Figure 6 can be used as a guiding index for defining parameters and according to glioma grade, velocities of growth and /. Indeed, this log to log graph includes all parameter values found up to Jan. 2007 for both lowand highgrade gliomas. Lowgrade gliomas are sited in bottom left rectangle (LGG), for 2 mm/yr average velocities. Respectively, high grade gliomas (HCG) are positioned in the large rectangle, defined by / of 2 to 20 cm2 and average velocities from 10mm/yr to 200mm/yr. On the left part gliomas with detectable mass, which can be cured with surgery, are placed. Figure 6. (Reproduced from [22])Loglog graph of and , for highand lowgrade gliomas. Continuing, for the case of heterogenous brain matter for highgrade gliomas, it is suggested in [4] that a typi cal value for is =0.0012 /day. This value for low grade gliomas can be defined at = 0.00012 /day. Then by assuming that =5, =102 mm2/day and =2 103 mm2/day can be used [19]. It is noteworthy to present the following table, repro duced from [23], where there is a list of the proposed val ues of each parameter that the latest glioma models use. 4. CHEMOTHERAPY MODELING Chemotherapy modeling is a quite blurred part of glioma models, which is mostly studied currently by researchers. Parameters that have to be taken into consideration Table 1. (Reproduced from [23])The parameters of the diffu sive model as proposed in the last 2 decades. Parameter (namely) Parameter Symbol Value Reference Growth Rate 0.012 [24] Diffusion Coefficient (Gray matter) 0.0013 ( [3] Diffusion Coefficient (White matter) 5 ( [4] Initial number of tumor cells [16,25] CT threshold density  400 (cells/ [4] CT threshold radius  1.5 [24] Cell death rate (chemotherapy) 0.0196 [26] Number of fractions/ day 1conventional (CR) 2hyperfractionated (HF) [27,28] Time interval (step) 1 (CR) 6 (HFR) [ 29,30]
506 A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 Copyright © 2010 SciRes. JBiSE should be extracted by histopathological and biostatis tical data of specific patients [31]. Swanson has intro duced a generalised net proliferation rate of chemothe rapy as: ()= () (8) where () is the temporal profile of the chemotherapy treatments, assuming a loss proportional to the strength or amount of therapy at a given time. Swanson sets ()= when the chemotherapy is being administered and ()= 0 otherwise. is actually a measure of effectiveness of chemotherapy. Thus, in order therapy to be effective and size of tumor to decrease, should be larger than , so that the net proliferation rate () is negative. This means the number of the dying cells is larger than the new born cells. An example of chemotherapy application on real clin ical MRI data, using (8) can be reproduced by [32]. In this example, k was intentionally set to the high value of ()=0.024, so as the cancer to have shrinking effect. The data (18 MRI slices) has been acquired by Univer sität des Saarlandes Klinikum (Germany) within the scope of the Contracancrum project [33]. The modeling results are given in Figure 7. The 3dimensional repre sentation of the initial and afterchemotherapy states are presented, accompanied by a sampled series of 4 MRI slices. 4.1. Mathematical Frameworks The increasing interest of researchers on diffusive mod els was remitted by the total absence on specific guide lines on how to design them mathematically. In 2009, Roniotis et al. [34] published a mathematical framework on designing diffusive models by using Finite Differ ences, for the needs of the ContraCancrum Project [33]. The framework includes heterogeneous tissue, aniso tropic migration of cells along white fibers and is 3D. Moreover, chemotherapy formalism of Eq.8 can also be incorporated in the model. Different schemes of finite differences have been de veloped, namely forward Euler, backward Euler, Crank Nikolson and θmethods. Moreover, the same model has been also developed with finite elements. The accuracy of the different schemes has been tested on simplified cases which suggested that the backward Euler scheme (Finite Differences) yields the best results. An example of applying this framework on real clinical data is dis played in Figure 8, reproduced from [34]. 5. CHALLENGES FOR FUTURE MODELS Simulations of applying therapy can be performed by adjusting the proliferation term according to glioma cell proliferation rates in the diffusion equation. More over, consecutive chemotherapy sessions have been simulated by works. However, the main issue govern ing these applications is the estimation of the most efficient model parameters. This requires study of pharmacokinetics and study of real chemotherapy ses sions on patients. Figure 7. (Reproduced from [32])MRI and 3D representation of glioma in. (a) initial state; (b) after chemotherapy simulation. 4 slices out of 18 slices are presented.
A. Roniotis et al. / J. Biomedical Science and Engineering 3 (2010) 501508 507 Copyright © 2010 SciRes. JBiSE Figure 8. (Reproduced from [34])results of modeling (left column) initial data, (central column) simulated data after 112 days, by using the backward euler scheme and (right column) real data on 112th day. An ideal model will have the ability to suggest paths of invasion, unseen by the doctor and help the clinician predict how the tumor is going to behave after different cures. Personalized parameter estimation for treatment term, proliferation rate and initial state are very impor tant for the model and are being studied by most re searchers working on diffusive models globally. Another important issue regarding modern diffusive models is the estimation of parameters of anisotropic diffusion. This is already incorporated in the models, but the methods used for extracting diffusion tensors have not been validated. This is mostly due to the use of DT MRI, that is a modern technique and is hard to accom pany all medical data. An estimation of tensors based on atlas could be studied. 6. CONCLUSIONS Mathematical diffusive modeling for simulating glioma growth and invasion is a currently developing scientific field. An efficient 3dimensional model of glioma growth will constitute a powerful tool for clinicians, since they could predict how glioma is going to develop in time. The most important part of this is the differen tiation of the predicted outcome according to the differ ent model input parameters. These parameters are changing with different therapy treatments. Thus the clinician can make an easier decision on which therapy scheme yields the best predictions. 7. ACKNOWLEDGEMENTS This work was supported in part by the EC ICT project ContraCan crum, Contract No: 223979. REFER ENC ES [1] Silbergeld, D.L., Rostomily, R.C. and Alvor d, Jr.E.C. (1991) The cause of death in patients with glioblastoma is multifactorial: Clinical factors and autopsy findings in 117 cases of suprantentorial glioblastoma in adults. Journal of N euroOncology, 10, 179185. [2] Swanson, K.R., True, L.D. and Murray, J.D. (2003) On the use of quantitative modeling to help understand PSA dynamics and other medical problems. American Journal of Clinical Pathology, 119(1), 1417. [3] Tracqui, P. (1995) From passive diffusion to active cellu lar migration in mathematical models of tumour invasion. Acta Bibliotheoretica, 43, 443464. [4] Swanson, K.R, Alvord, E.C. and Murray, J.D. (2000) A quantitative model for differential motility of gliomas in grey and white matter. Cell Proliferation, 33(5), 317330. [5] Burgess, P.K., Kulesa, P.M., Murray, J.D. and Alvord, E.C, (1997) The interaction of growth rates and diffusion coef ficients in a threedimensional mathematical model of gliomas. Journal of Neuropathology & Experimental Neurology, 56, 704713. [6] Wheldon, T.E. (1986) Mathematical models in experi mental and clinical oncology. In: Ingrain, D. and Bloch, R.F., Eds, Mathematical Methods in Medicine, John Wiley & Sons, Chichester, 132. [7] Adam, J.A. and Maggelakis, S.A. (1990) Diffusion regu lated growth characteristics of a spherical prevascular carcinoma. Bulletin of Mathematical Biology, 52, 549582. [8] Lefever, R., Hiemaux, J. and Meyers, P. (1989) Evolution of tumours attacked by immune cytotoxic cells: The im mune response dilemma. In: Goldbetor, A., Ed., Cell to Cell Signaling: From Experiments to Theoretical Models, Academic Press, Boston, 315333. [9] Sherratt, J.A. and Nowa, M.A. (1992) Oneogenes, an tioncogenes and the immune response to cancer a ma thematical model. Proceeding of the Royal Society of London, B 248, 261271. [10] Dionysiou, D., Stamatakos, G.S., Uzunoglu, N.K., Nikita, K.S., Marioli, A. (2004) A fourdimensional simulation model of tumour response to radiotherapy in vivo: Para metric validation considering radiosensitivity, genetic profile and fractionation. Journal of Theoretical Biology, 230(1), 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1 5275995&query_hl=2 [11] Clatz, O., Sermesant, M., Bondiau, P., Delingette, H., Warfield, S.K., Malandain, G. and Ayache, N. (2005) Realistic simulation of the 3D growth of brain tumours in MR images coupling diffusion with biomechanical de formation. IEEE Transactions on Medical Imaging, 24, 13341346.
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