Mechano-biological features in a patient-specific computational model of glioblastoma

Despite the technical-scientific developments of the last decades, the prognosis of patients affected by glioblastoma (GBM) still remains poor due to the extensive invasion and diffusion of tumor cells anywhere within the host brain tissue, which makes almost impossible the complete surgical removal. Furthermore, although the blood-brain barrier (BBB) is typically disrupted at the core of GBM, it can be structurally conserved at the tumor periphery, allowing infiltrative and spreading glioma cells to escape chemotherapy-induced death. In this chapter, the authors present an innovative mechano-biological approach to study and describe the GBM progression taking into account not only biochemical factors but also mechanical interactions occurring between the local micro-environment and the tumor. This model is based upon the experimental evidence of a preferential diffusion of glioma cells among white matter fiber tracts, detectable by preoperative patient-specific diffusion tensor imaging. The possibility of predicting tumor patterns of recurrence could potentially modify the therapeutic strategies, by guiding resection including a supramaximal removal in the areas at higher risk of recurrence, and by improving the planning of radiation therapy, possibly increasing the patient survival.