Nakagawa H, Fujita T, Kubo S, Tsuruzono K, Yamada M, Tokiyoshi K, Miyawaki Y, Kanayama T, Kadota T, Hayakawa T
Department of Neurosurgery and Radiology, Center for Adult Diseases, Osaka, Japan.
Surg Neurol. 1994 Jan;41(1):19-27. doi: 10.1016/0090-3019(94)90203-8.
We administered selective intra-arterial chemotherapy consisting of a combination of etoposide and cisplatin to 20 patients with malignant glioma (seven with recurrent and six with enlarged tumors after initial treatment, and seven newly diagnosed patients). Evaluation of efficacy was based on computed tomographic and magnetic resonance imaging findings. In the process of establishing a safe technique for superselective intra-arterial chemotherapy, we encountered cerebrovascular accidents in two patients (after etoposide in one and after etoposide plus cisplatin in the other). In these two cases, 100 mg/m2 of etoposide and 100 mg/m2 of cisplatin were delivered via the horizontal segment of the middle cerebral artery (M1) or the tip of the basilar artery, with the infusion time reduced to 20 minutes. Thereafter, the etoposide was diluted, and the doses of both drugs were reduced to 80 or 50 mg/m2, and finally to 60 mg/m2, and both were infused over 60 minutes. In addition, for prevention of local spasm, papaverine hydrochloride and nicardipine were given via the same catheter at 5-minute intervals during administration of etoposide and cisplatin. No complications developed in the later cases. Thereafter, selective intra-arterial infusion of etoposide and cisplatin into the anterior cerebral artery, middle cerebral artery, posterior cerebral artery, or the basilar artery for malignant gliomas in the basal ganglia, internal capsule, and brainstem--a procedure generally considered risky in terms of potential complications--was performed safely, with tolerable side effects. Computed tomography and magnetic resonance imaging indicated improvement in 13 patients, including four whose tumors completely disappeared. This method of intra-arterial chemotherapy may be useful as an adjuvant treatment for malignant glioma.
我们对20例恶性胶质瘤患者（7例复发患者、6例初始治疗后肿瘤增大患者以及7例新诊断患者）实施了由依托泊苷和顺铂联合组成的选择性动脉内化疗。疗效评估基于计算机断层扫描和磁共振成像结果。在建立超选择性动脉内化疗安全技术的过程中，我们有2例患者发生了脑血管意外（1例在使用依托泊苷后，另1例在使用依托泊苷加顺铂后）。在这2例中，100mg/m²的依托泊苷和100mg/m²的顺铂经大脑中动脉（M1）水平段或基底动脉顶端给药，输注时间缩短至20分钟。此后，依托泊苷进行了稀释，两种药物的剂量均减至80或50mg/m²，最后减至60mg/m²，且均在60分钟内输注完毕。此外，为预防局部痉挛，在输注依托泊苷和顺铂期间，每隔5分钟经同一导管给予盐酸罂粟碱和尼卡地平。后续病例未出现并发症。此后，针对基底节、内囊和脑干恶性胶质瘤，将依托泊苷和顺铂选择性动脉内输注至大脑前动脉、大脑中动脉、大脑后动脉或基底动脉——这一操作通常因潜在并发症而被认为具有风险——得以安全实施，且副作用可耐受。计算机断层扫描和磁共振成像显示13例患者病情改善，其中4例肿瘤完全消失。这种动脉内化疗方法可能作为恶性胶质瘤的辅助治疗手段有用。
