Fig. 3. Radiologic and immunologic analyses of tumors after treatment.

(A) Three patients with suspected progression after treatment underwent re-resection of contrast-enhancing suspected tumor. The MRI images shown are from one patient who had a right occipital recurrent GBM resected. The MRI scans from 1 day after surgery (baseline) and from weeks 4, 8, and 24 are shown. The injections were given in an area of the occipital lobe and one area more superior toward the parietal lobe. Red and yellow arrows show areas with changes in enhancement in the occipital and parietal needle tracks. (B) Left panels: GBM from the patient shown in (A) at the time of resection before injection of Ad–RTS–hIL-12 [shown in the top panel at 20× magnification (scale bar, 100 μm) and in the bottom panel at 100× magnification (scale bar, 50 μm)]. Right panels: GBM from the same patient 175 days after treatment (at the time of suspected pseudoprogression). Resected material from the occipital lesion was analyzed by immunofluorescence histochemistry for expression of CD3⁺ (yellow), CD8⁺ (red), CD3⁺CD8⁺ (orange), PD-1⁺ (green), PD-L1⁺ (cyan), and GFAP (white) [shown in the top panel at 20× magnification (scale bar, 100 μm) and in the bottom panel at 100× magnification (scale bar, 50 μm)]. (C and D) Quantitative analyses of baseline and posttreatment expression of immunologic markers in tumors for the three patients undergoing re-resection after injection. (C) Counts of CD3⁺-, CD3⁺CD8⁺-, PD-1⁺-, CD3⁺CD4⁺FoxP3⁺-, CD56⁺-, and PD-L1⁺–expressing cells per square millimeter of tumor. (D) IFN-γ in the three GBMs before and after treatment.