Schwake Michael, Müther Michael, Bruns Ann-Katrin, Zinnhardt Bastian, Warneke Nils, Holling Markus, Schipmann Stephanie, Brokinkel Benjamin, Wölfer Johannes, Stummer Walter, Grauer Oliver
Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany.
European Institute for Molecular Imaging (EIMI), University of Münster, 48149 Münster, Germany.
Cancers (Basel). 2022 Jan 21;14(3):541. doi: 10.3390/cancers14030541.
Concepts improving local tumor control in high-grade glioma (HGG) are desperately needed. The aim of this study is to report an extended series of cases treated with a combination of 5-ALA-fluorescence-guided resection (FGR) and intracavitary thermotherapy with superparamagnetic iron oxide nanoparticles (SPION).
We conducted a single-center retrospective review of all recurrent HGG treated with FGR and intracavitary thermotherapy ( = 18). Patients underwent six hyperthermia sessions in an alternating magnetic field and received additional adjuvant therapies on a case-by-case basis.
Nine patients were treated for first tumor recurrence; all other patients had suffered at least two recurrences. Nine patients received combined radiotherapy and thermotherapy. The median progression-free survival was 5.5 (95% CI: 4.67-6.13) months and median overall survival was 9.5 (95% CI: 7.12-11.79) months. No major side effects were observed during active treatment. Thirteen patients (72%) developed cerebral edema and more clinical symptoms during follow-up and were initially treated with dexamethasone. Six (33%) of these patients underwent surgical removal of nanoparticles due to refractory edema.
The combination of FGR and intracavitary thermotherapy with SPION provides a new treatment option for improving local tumor control in recurrent HGG. The development of cerebral edema is a major issue requiring further refinements of the treatment protocol.
迫切需要改善高级别胶质瘤（HGG）局部肿瘤控制的理念。本研究的目的是报告一系列采用5-氨基乙酰丙酸荧光引导切除术（FGR）和超顺磁性氧化铁纳米颗粒（SPION）腔内热疗联合治疗的病例。
我们对所有接受FGR和腔内热疗的复发性HGG进行了单中心回顾性研究（n = 18）。患者在交变磁场中接受六次热疗，并根据具体情况接受额外的辅助治疗。
9例患者接受首次肿瘤复发治疗；所有其他患者至少经历过两次复发。9例患者接受了放疗和热疗联合治疗。无进展生存期的中位数为5.5（95%CI：4.67 - 6.13）个月，总生存期的中位数为9.5（95%CI：7.12 - 11.79）个月。在积极治疗期间未观察到严重副作用。13例患者（72%）在随访期间出现脑水肿和更多临床症状，最初用地塞米松治疗。其中6例（33%）患者因难治性水肿接受了纳米颗粒手术清除。
FGR和SPION腔内热疗联合为改善复发性HGG的局部肿瘤控制提供了一种新的治疗选择。脑水肿的发生是一个主要问题，需要进一步完善治疗方案。
