Fujiwara T, Matsumoto Y, Tsuchida T, Honma Y, Mino S, Nagao S
Dept. of Neurological Surgery, Kagawa Medical School.
Gan To Kagaku Ryoho. 1992 Apr;19(4):489-95.
Twelve patients with supratentorial gliomas were treated with intra-arterial ACNU followed by intravenous maintenance chemotherapy. Six of the patients, treated from February 1987 through May 1989, received doses of 120-200 mg/m2 (high dose treatment group); six patients, treated from June 1989 through October 1990, received doses of 80-100 mg/m2 (low dose treatment group). The drug was given via the supraophthalmic portion of the internal carotid artery or vertebral artery at a rate of 10 mg/min. The response rate (CR + PR) on CT scan was 50% (3/6) in the high dose treatment group and 17% (1/6) in the low dose treatment group. Survival periods from first operation, however, did not differ between the high and low dose treatment groups. Bone marrow suppression was dose-related and reversible at these doses. Severe neurotoxicities (hemiparesis and aphasia) developed in the patients who received 200 mg/m2 of ACNU; in one case, this was irreversible. High dose intra-arterial ACNU chemotherapy is effective in reducing tumor size on CT scan but the prognosis is not improved. The dose limiting factor of intra-arterial nitrosourea is neurotoxicity, and doses of more than 200 mg/m2 are considered to be dangerous.
12例幕上胶质瘤患者接受动脉内注射阿糖胞苷（ACNU）治疗，随后进行静脉维持化疗。其中6例患者于1987年2月至1989年5月接受治疗，剂量为120 - 200mg/m²（高剂量治疗组）；另外6例患者于1989年6月至1990年10月接受治疗，剂量为80 - 100mg/m²（低剂量治疗组）。药物通过颈内动脉或椎动脉的眼上部分以10mg/min的速度注入。高剂量治疗组CT扫描的缓解率（CR + PR）为50%（3/6），低剂量治疗组为17%（1/6）。然而，高剂量和低剂量治疗组自首次手术起的生存期并无差异。在这些剂量下，骨髓抑制与剂量相关且可逆。接受200mg/m²ACNU的患者出现了严重的神经毒性（偏瘫和失语）；其中1例为不可逆性。高剂量动脉内ACNU化疗在CT扫描上可有效缩小肿瘤大小，但预后并未改善。动脉内亚硝基脲的剂量限制因素是神经毒性，超过200mg/m²的剂量被认为是危险的。
