Shimato Shinji, Nishizawa Toshihisa, Ohshima Tomotaka, Imai Tasuku, Goto Shunsaku, Yamamoto Taiki, Kato Kyozo
Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
World Neurosurg. 2016 Jun;90:340-347. doi: 10.1016/j.wneu.2016.02.102. Epub 2016 Mar 4.
Bis-chloroethylnitrosourea (BCNU) wafers have been demonstrated to be effective for prolonging survival for patients with malignant glioma and have been approved worldwide. BCNU wafers are implantable and have a unique feature of delivering chemotherapeutic drug at high concentration at tumor margin over time after resection. BCNU wafers presumably, by this mechanistic rationale, have a beneficial effect on local tumor control and thus could change the pattern of recurrence, which is most frequently local. However, no studies have demonstrated such phenomenon after BCNU wafer implants.
To investigate whether the surgeries with BCNU wafers alter the predominant tendency of local recurrence pattern, we retrospectively reviewed 8 malignant glioma patients treated with BCNU wafers (BCNU wafer group), together with 22 glioma patients who did not receive BCNU wafers (no-BCNU wafer group) for comparison.
Out of 6 patients in BCNU wafer group who exhibited recurrence, 1 showed local, 2 showed diffuse, and 3 showed a distant recurrence pattern, which was away from resection cavity. On the other hand, out of 18 patients in the no-BCNU wafer group who exhibited recurrence, 10 showed a local pattern, 8 showed a diffuse pattern, and no cases showed distant pattern. Distant pattern was observed significantly more frequently in the BCNU wafer group than in the no-BCNU wafer group.
These results suggest that BCNU wafers could have a beneficial effect on local tumor control and may provide BCNU wafers with a new profile that could be considered for establishing future chemotherapeutic strategy for glioma patients.
双氯乙基亚硝脲（BCNU）薄片已被证明对延长恶性胶质瘤患者的生存期有效，并已在全球范围内获得批准。BCNU薄片是可植入的，具有在切除后随时间在肿瘤边缘高浓度释放化疗药物的独特特性。根据这一机制原理，BCNU薄片可能对局部肿瘤控制有有益作用，从而可能改变最常见的局部复发模式。然而，尚无研究证明BCNU薄片植入后会出现这种现象。
为了研究使用BCNU薄片的手术是否会改变局部复发模式的主要趋势，我们回顾性分析了8例接受BCNU薄片治疗的恶性胶质瘤患者（BCNU薄片组），并与22例未接受BCNU薄片治疗的胶质瘤患者（无BCNU薄片组）进行比较。
BCNU薄片组6例出现复发的患者中，1例为局部复发，2例为弥漫性复发，3例为远处复发，即远离切除腔的复发。另一方面，无BCNU薄片组18例出现复发的患者中，10例为局部复发模式，8例为弥漫性复发模式，无远处复发模式。BCNU薄片组远处复发模式的观察频率明显高于无BCNU薄片组。
这些结果表明，BCNU薄片可能对局部肿瘤控制有有益作用，并可能为BCNU薄片提供一种新的特征，可考虑用于制定未来胶质瘤患者的化疗策略。
