Han Dayong, Teng Lei, Wang Xiaoxiong, Zhen Yunbo, Chen Xiaofeng, Yang Mingchun, Gao Ming, Yang Guang, Han Mingyang, Wang Ligang, Xu Jiajun, Li Yue, Shumadalova Alina, Zhao Shiguang
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Institute of Brain Science, Harbin Medical University, Harbin, China.
Front Neurol. 2022 Aug 30;13:1001829. doi: 10.3389/fneur.2022.1001829. eCollection 2022.
Glioma is the most common primary brain tumor in adults with poor prognosis. The glioma patients benefit from STUPP strategy, including maximum and safe resection and adjuvant radiotherapy and chemotherapy. Arsenic trioxide could inhibit various tumors. However, it is a challenge to evaluate the efficiency and safety of srsenic trioxide in glioma patients.
The arsenic trioxide has the potent therapeutic effect on glioma. However, the safety and efficacy of local interstitial chemotherapy with arsenic trioxide in newly diagnosed glioma patients is unclear.
All patients received partial or complete tumor resection and intraoperative implantation of Ommaya reservoirs followed by standard radiotherapy. Arsenic trioxide with the starting dose 0.3 mg was administered an Ommaya reservoir catheter inserted into the tumor cavity for 5 consecutive days every 3 months for a total of eight cycles unless tumor progression or excessive toxicity was observed.
No hematological or grade 4 non-hematological toxicity was observed in any patient during arsenic trioxide treatment. The maximum tolerated dose of 1.5 mg of arsenic trioxide was safe and well tolerated. The median overall survival for WHO grade 3 glioma was 33.6 months, and for glioblastoma was 13.9 months. The median progression-free survival for WHO grade 2 glioma was 40.3 months, for grade 3 glioma was 21.5 months, and for glioblastoma was 9.5 months.
These results suggest that arsenic trioxide is safe and well tolerated with local delivery into the tumor cavity of the brain, and the dose recommended for a phase II trial is 1.5 mg.
胶质瘤是成人中最常见的原发性脑肿瘤，预后较差。胶质瘤患者可从STUPP方案中获益，该方案包括最大限度的安全切除以及辅助放疗和化疗。三氧化二砷可抑制多种肿瘤。然而，评估三氧化二砷在胶质瘤患者中的有效性和安全性是一项挑战。
三氧化二砷对胶质瘤具有显著的治疗作用。然而，新诊断的胶质瘤患者局部间质化疗使用三氧化二砷的安全性和有效性尚不清楚。
所有患者均接受了部分或完全肿瘤切除，并在术中植入Ommaya储液器，随后进行标准放疗。起始剂量为0.3mg的三氧化二砷通过插入肿瘤腔的Ommaya储液器导管给药，每3个月连续5天，共8个周期，除非观察到肿瘤进展或出现过度毒性。
在三氧化二砷治疗期间，未观察到任何患者出现血液学毒性或4级非血液学毒性。1.5mg三氧化二砷的最大耐受剂量是安全的，耐受性良好。世界卫生组织3级胶质瘤的中位总生存期为33.6个月，胶质母细胞瘤为13.9个月。世界卫生组织2级胶质瘤的中位无进展生存期为40.3个月，3级胶质瘤为21.5个月，胶质母细胞瘤为9.5个月。
这些结果表明，三氧化二砷通过局部注入脑肿瘤腔是安全且耐受性良好的，推荐用于II期试验的剂量为1.5mg。
