Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review
Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review
复制标题
对流增强盐酸尼莫司汀给药后复发性脊髓高级别胶质瘤的消退：病例报告和文献综述
DOI：
10.1093/ons/opz172
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Tominaga T.
中科院分区：
文献类型：
--
作者：
Endo T;Inoue T;Sugiyama S;Saito R;Tominaga T.
背景脊髓高级别胶质瘤预后较差。目的探讨一种新的治疗方法--对流增强递送(CED)治疗复发高级别胶质瘤。CED可以直接将化疗药物输送到髓内病变，并可能导致增大的肿瘤显著消退，否则难以控制。方法2例患者发展为胸髓高级别胶质瘤。肿瘤部分切除加化疗、放疗后病情缓解。然而，在最初的治疗后，脊髓分别在6个月和12个月时复发。对于这些复发的皮损，没有有效的治疗方法。因此，作者决定使用CED将盐酸尼莫司汀(ACNU)直接注入脊髓。术中CT扫描下将输液插管插入脊髓病变部位。结果两例患者ACNU CED后，连续的磁共振成像均证实肿瘤明显缩小。然而，患者的输液前症状，包括双侧下肢无力，在治疗后没有改变。重要的是，2例患者的总生存期分别为67个月和33个月。结论作者报道了首例复发的脊髓高级别胶质瘤。ACNU CED显著消退了强化的肿块病变，并提供了脊髓局部肿瘤控制。
BACKGROUNDSpinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases.OBJECTIVETo apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control.METHODSTwo patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan.RESULTSAfter ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo.CONCLUSIONThe authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.