Vitamin D Levels In Blood And Survival In Glioblastoma

Vitamin D has antitumor functions in the body. 1,25(OH)2D3 (calcitriol) functions can be divided into two groups, one of endocrine nature implied in the bone biology regulation and other recently discovered with paracrine and autocrine character, holding immunomodulatory capacity. The immunomodulatory effect of calcitriol was discovered in 2010 and is based on the innate immunity enhancement and the adaptive immunity inhibition. This effect is noted through several mediators including the tumor hypoxia factor HIF-1 or the increase of the E-cadherin involved in the epithelial-mesenchymal transition (EMT), observing a decrease in the inflammatory effect, cellular proliferation, metastasis and angiogenesis, also with an increase of cellular apoptosis. We retrospectively analyzed patients’ blood vitamin D levels in patients diagnosed of glioblastoma (GM) at our institution. Vitamin D levels were studied prior to the start of the chemotherapeutic and radiotherapeutic treatment in 32 patients (17 males and 15 females) with an average age of 59 years (36-76) diagnosed with GM. 6 of the 32 patients (18.8%) had IDH1 mutation and the rest were IDHwt (81.3%). 18 patients (56.3%) presented values higher than 30 ng/ml while 14 patients (43.8%) had lower values. Median progression free survival was 5,14 months in lower values and 12,24 months in values higher than 30 ng/ml (P = 0.000). Overall survival was 7.38 month in first group and 18.11 months in second group (P = 0.000) Patients with high levels of calcidiol had a greater pseudoprogression effect as evidenced by MR with spectroscopy in the first radiographic control (P = 0.029). Kaplan-Meier and multivariable modeling revealed that IDH mutations was a predictive factor for improved survival (P = 0.004). There were no differences in tolerance to treatment, in sex, in the type of surgical intervention or in the location of the lesion. Vitamin D deficiency might be a potential therapeutic target in glioblastoma. However, additional studies are needed to establish optimal serum levels for patients with glioblastoma.