Newton Herbert B, Slivka Mary A, Volpi Carol, Bourekas Eric C, Christoforidis Gregory A, Baujan Melissa A, Slone Wayne, Chakeres Donald W
Division of Neuro-Oncology, Department of Neurology, The Ohio State University Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
J Neurooncol. 2003 Jan;61(1):35-44. doi: 10.1023/a:1021218207015.
Metastatic brain tumors (MBT) are the most frequent complication of systemic cancer and often respond poorly to treatment. Median survival is only 16-24 weeks after conventional radiation therapy. Regional intra-arterial (IA) administration of chemotherapy results in increased tumor uptake of drug and may improve response rates and survival. Twenty-seven patients with MBT who had received prior irradiation were treated with IA carboplatin (200 mg/m2/d) and intravenous (i.v.) etoposide (100 mg/m2/d) for 2 days every 3-4 weeks. Eighteen patients (67%) had received prior systemic chemotherapy for their primary tumor. Patients ranged in age from 19 to 68 years (mean 48.1). Thirteen of 24 evaluable patients had objective responses (54.2%). There were 6 complete responses (25%), 6 partial responses (25%), 1 minor response (4.2%), 7 stable disease (32%), and 5 progressive disease (20.8%). Some patients with multifocal tumors had a mixture of responses. The median time to progression was 16.0 weeks overall and 30.0 weeks in responders (range 6-118 weeks). Overall median survival from the time of protocol initiation was 20.0 weeks. In six responders, death occurred due to systemic illness unrelated to MBT progression. Therapy was well tolerated, with predominantly hematologic toxicity. Angiographic complications were rare. Although these are preliminary results, IA carboplatin and IV etoposide is safe and well tolerated, appears to be active against brain metastases, and warrants further study.
转移性脑肿瘤（MBT）是系统性癌症最常见的并发症，通常对治疗反应不佳。传统放射治疗后中位生存期仅为16 - 24周。区域动脉内（IA）化疗可使肿瘤药物摄取增加，并可能提高缓解率和生存率。27例曾接受过放疗的MBT患者接受IA卡铂（200 mg/m²/天）和静脉注射（i.v.）依托泊苷（100 mg/m²/天）治疗，每3 - 4周治疗2天。18例（67%）患者曾因原发性肿瘤接受过全身化疗。患者年龄在19至68岁之间（平均48.1岁）。24例可评估患者中有13例出现客观缓解（54.2%）。其中6例完全缓解（25%），6例部分缓解（25%），1例轻微缓解（4.2%），7例病情稳定（32%），5例病情进展（20.8%）。一些有多发性肿瘤的患者有混合性反应。总体疾病进展的中位时间为16.0周，缓解者为30.0周（范围6 - 118周）。从方案开始时起总体中位生存期为20.0周。6例缓解者因与MBT进展无关的全身性疾病死亡。治疗耐受性良好，主要为血液学毒性。血管造影并发症罕见。尽管这些是初步结果，但IA卡铂和静脉注射依托泊苷安全且耐受性良好，似乎对脑转移瘤有效，值得进一步研究。
