Dropcho E J, Rosenfeld S S, Vitek J, Guthrie B L, Morawetz R B
Department of Neurology, Indiana University Medical Center, Indianapolis 46202-5111, USA.
J Neurooncol. 1998 Jan;36(2):191-8. doi: 10.1023/a:1005871721697.
To assess the response of patients with recurrent malignant gliomas to intra-arterial (IA) cisplatin.
Eligibility criteria included patients with recurrent supratentorial malignant gliomas and measurable, unilateral contrast-enhancing tumor located within the territory of one or two major cerebral arteries. Patients received 75 mg/m2 IA cisplatin every four weeks. Depending on individual patients' tumor topography, cisplatin was infused either into the cervical internal carotid artery (ICA) (15 patients), or into one or two major cerebral arteries (26 patients), most often the M1 segment of the middle cerebral artery.
Of 40 patients evaluable for tumor response, four patients (10%) were responders and nine patients (22%) had disease stabilization. The median time to tumor progression among the 13 patients with tumor response or stable disease was 23.7 weeks. The response rate did not significantly differ between patients receiving ICA versus selective intracerebral infusion, although the latter group contained a higher proportion of glioblastoma. Tumor progression occurred solely as local failure in 33 patients (82%), with all enhancing tumor still located within the vascular territory infused with IA cisplatin. Ipsilateral vision loss occurred in two patients after ICA cisplatin but in none of the selective infusion patients. Seizures and/or transient or permanent neurologic deterioration occurred in four patients (27%) after ICA cisplatin and in 11 patients (44%) after selective intracerebral infusion.
Although this was not a randomized comparison, selective intracerebral artery cisplatin infusion in this group of patients reduced the risk of eye toxicity, but did not produce a better tumor response rate, and carried a higher risk of neurotoxicity relative to ICA infusion.
评估复发性恶性胶质瘤患者对动脉内（IA）顺铂的反应。
入选标准包括患有复发性幕上恶性胶质瘤且有可测量的、位于一或两条大脑主要动脉供血区域内的单侧强化肿瘤的患者。患者每四周接受75mg/m²的IA顺铂治疗。根据个体患者的肿瘤位置，顺铂可注入颈内动脉（ICA）（15例患者），或注入一或两条大脑主要动脉（26例患者），最常见的是大脑中动脉的M1段。
在40例可评估肿瘤反应的患者中，4例患者（10%）有反应，9例患者（22%）病情稳定。13例有肿瘤反应或病情稳定的患者中，肿瘤进展的中位时间为23.7周。接受ICA注射与选择性脑内注射的患者之间的反应率无显著差异，尽管后一组中胶质母细胞瘤的比例更高。33例患者（82%）的肿瘤进展仅表现为局部复发，所有强化肿瘤仍位于注入IA顺铂的血管区域内。2例接受ICA顺铂注射的患者出现同侧视力丧失，而选择性注射患者中无一例出现。4例接受ICA顺铂注射的患者（27%）和接受选择性脑内注射的11例患者（44%）出现癫痫发作和/或短暂或永久性神经功能恶化。
尽管这不是一项随机对照研究，但在这组患者中选择性脑动脉顺铂注射降低了眼毒性风险，但未产生更好的肿瘤反应率，且相对于ICA注射，神经毒性风险更高。
