Background: IDH-wild-type glioblastoma (GBM) is the most frequent brain-derived malignancy. Despite intense research efforts, it is still associated with a very poor prognosis. Several parameters were identified as prognostic, including general physical performance. In neuro-oncology (NO), special emphasis is put on focal deficits and cognitive (dys-)function. The Neurologic Assessment in Neuro-Oncology (NANO) scale was proposed in order to standardize the assessment of neurological performance in NO. This study evaluated whether NANO scale assessment provides prognostic information in a standardized collective of GBM patients. Methods: The records of all GBM patients treated between 2014 and 2019 at our facility were retrospectively screened. Inclusion criteria were age over 18 years, at least 3 months postoperative follow-up, and preoperative and postoperative cranial magnetic resonance imaging. The NANO scale was assessed pre- and postoperatively as well as at 3 months follow-up. Univariate and multivariate survival analyses were carried to investigate the prognostic value. Results: One hundred and thirty-one patients were included. In univariate analysis, poor postoperative neurological performance (HR 1.13, p = 0.004), poor neurological performance at 3 months postsurgery (HR 1.37, p < 0.001), and neurological deterioration during follow-up (HR 1.38, p < 0.001), all assessed via the NANO scale, were associated with shorter survival. In multivariate analysis including other prognostic factors such as the extent of resection, adjuvant treatment regimen, or age, NANO scale assessment at 3 months postoperative follow-up was independently associated with survival prediction (HR 1.36, p < 0.001). The optimal NANO scale cutoff for patient stratification was 3.5 points. Conclusion: Neurological performance assessment employing the NANO scale might provide prognostic information in patients suffering from GBM.

A better understanding of tumour heterogeneity is central for accurate diagnosis, targeted therapy and personalised treatment of glioblastoma patients. This thesis aims to investigate whether pre-operative multi-parametric magnetic resonance imaging (MRI) can provide a useful tool for evaluating inter-tumoural and intra-tumoural heterogeneity of glioblastoma. For this purpose, we explored: 1) the utilities of habitat imaging in combining multi-parametric MRI for identifying invasive sub-regions (I & II); 2) the significance of integrating multi-parametric MRI, and extracting modality inter-dependence for patient stratification (III & IV); 3) the value of advanced physiological MRI and radiomics approach in predicting epigenetic phenotypes (V). The following observations were made: I. Using a joint histogram analysis method, habitats with different diffusivity patterns were identified. A non-enhancing sub-region with decreased isotropic diffusion and increased anisotropic diffusion was associated with progression-free survival (PFS, hazard ratio [HR] = 1.08, P < 0.001) and overall survival (OS, HR = 1.36, P < 0.001) in multivariate models. II. Using a thresholding method, two low perfusion compartments were identified, which displayed hypoxic and pro-inflammatory microenvironment. Higher lactate in the low perfusion compartment with restricted diffusion was associated with a worse survival (PFS: HR = 2.995, P = 0.047; OS: HR = 4.974, P = 0.005). III. Using an unsupervised multi-view feature selection and late integration method, two patient subgroups were identified, which demonstrated distinct OS (P = 0.007) and PFS (P < 0.001). Features selected by this approach showed significantly incremental prognostic value for 12-month OS (P = 0.049) and PFS (P = 0.022) than clinical factors. IV. Using a method of unsupervised clustering via copula transform and discrete feature extraction, three patient subgroups were identified. The subtype demonstrating high inter-dependency of diffusion and perfusion displayed higher lactate than the other two subtypes (P = 0.016 and P = 0.044, respectively). Both subtypes of low and high inter-dependency showed worse PFS compared to the intermediate subtype (P = 0.046 and P = 0.009, respectively). V. Using a radiomics approach, advanced physiological images showed better performance than structural images for predicting O6-methylguanine-DNA methyltransferase (MGMT) methylation status. For predicting 12-month PFS, the model of radiomic features and clinical factors outperformed the model of MGMT methylation and clinical factors (P = 0.010). In summary, pre-operative multi-parametric MRI shows potential for the non-invasive evaluation of glioblastoma heterogeneity, which could provide crucial information for patient care.

Le médulloblastome est une des tumeurs les plus fréquentes du système nerveux central chez l’enfant. Son impact clinique, ainsi que les effets secondaires engendrés par les traitements actuels, sont significatifs en matière de morbidité et de mortalité. La caractérisation moléculaire des tumeurs du système nerveux central a grandement évolué, et ce, particulièrement en ce qui concerne le médulloblastome. Des travaux antérieurs ont permis d’établir qu’un des sous-groupes de médulloblastome est caractérisé par l’activation de la voie sonic hedgehog. La mutation la plus fréquente menant à ce sous-type de médulloblastome est la mutation du gène suppresseur de tumeur PTCH1. Grâce au modèle de souris Ptch1+/-, des données issues de notre laboratoire ont permis de caractériser le développement de cette tumeur comme étant en deux étapes. Ce travail porte sur la caractérisation du mécanisme par lequel cette première étape, soit la perte d’hétérozygotie de Ptch1, survient. Tout d’abord, nous revisitons le rôle in vivo du corécepteur Boc dans la tumorigenèse. Selon nos résultats, la modulation de Boc ne semble pas avoir un impact significatif sur le développement tumoral dans des expériences de transplantation orthotopiques. Ensuite, nous démontrons que le ligand Shh augmente le dommage à l’ADN, ce qui mène à une hausse des évènements de recombinaisons qui peuvent causer une perte d’hétérozygotie. Nous tentons de moduler l’activité de Rad51 en observant une tendance non statistiquement significative des évènements de recombinaison avec des inhibiteurs de Rad51. Nous démontrons ensuite qu’un inhibiteur de Cdc7 permet la diminution des évènements de recombinaisons ainsi qu’une diminution du stress réplicatif de l’ADN. En intervenant sur le gène Mcm2 grâce à un modèle de souris transgénique, nous parvenons à prouver qu’une diminution de l’action de Mcm2 permet une diminution du stress réplicatif de l’ADN. En somme, la première étape du développement du médulloblastome sonic hedgehog-activé est la perte d’hétérozygotie de Ptch1. Celle-ci est caractérisée par une augmentation du dommage à l’ADN engendrant une hausse des évènements de recombinaison. Plusieurs cibles potentielles de modulation s’avèrent prometteuses pour un éventuel traitement ciblé. / Medulloblastoma is one of the most common central nervous system tumors of the child. Its clinical impact, as well as the adverse effects caused by current treatments, are significant in terms of morbidity and mortality. The molecular characterization of tumors of the central nervous system has greatly evolved, particularly in the case of medulloblastoma. Previous work has established that one of the medulloblastoma sub-groups is characterized by the activation of the sonic hedgehog (Shh) pathway. The most common mutation leading to this medulloblastoma subtype is the PTCH1 tumor suppressor gene mutation. Working with the Ptch1+/- mouse model, data from our la-boratory characterized the medulloblastoma tumorigenesis as a two-step process. This work focuses on the characterization of the mechanism by which this first step, the loss of heterozygosity of Ptch1, occurs. First, we revisit the in vivo role of the Boc coreceptor in the medulloblastoma tumor-igenesis. According to our results, Boc modulation does not seem to have a significant impact on tumor development. Next, we show that the Shh ligand increases DNA dam-age. This leads to an increase in recombination events which predispose to loss of het-erozygosity. We attempt to modulate Rad51 activity and observe a non-statistically sig-nificant trend to decrease recombination events with Rad51 inhibitors. We then demonstrate that Cdc7 inhibition reduces recombination events as well as DNA replica-tive stress. Using an Mcm2 transgenic mouse model, we demonstrate that a reduction in the action of Mcm2 reduces DNA replicative stress. To conclude, the first step in the development of Shh-activated medulloblastoma is the loss of heterozygosity of Ptch1. This is characterized by an increase in DNA damage leading to an increase in recombination events. Several potential modulation targets hold promise for possible targeted therapy.