Enhanced chemotherapy delivery by intraarterial infusion and blood-brain barrier disruption in the treatment of cerebral metastasis
Enhanced chemotherapy delivery by intraarterial infusion and blood-brain barrier disruption in the treatment of cerebral metastasis
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DOI：
10.1002/cncr.22450
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发表时间：
2007-02-15
期刊：
影响因子：
6.2
通讯作者：
Garant, Marie-Pierre
中科院分区：
文献类型：
--
作者：
Fortin, David;Gendron, Cathy;Garant, Marie-Pierre
背景。 10% 至 30% 的肿瘤患者脑转移具有临床意义。多发性脑转移瘤通常采用姑息性放疗进行治疗。对于强化化疗作为该疾病的辅助治疗方式的作用尚未达成共识。在本报告中，作者详细介绍了他们在多发性脑转移瘤患者中使用或不使用血脑屏障破坏 (BBBD) 的动脉内 (IA) 化疗输注的经验。方法。 1999年11月至2005年5月，38名多发性脑转移患者参加了一项前瞻性研究。除全身性淋巴瘤脑转移患者接受 IA 甲氨蝶呤治疗外，患者均接受 IA 卡铂治疗。向患者提供渗透性 BBBD，没有出现明显的质量效应。这些方案与静脉注射依托泊苷和环磷酰胺相结合。每 4 周重复一次循环。 结果。生存率根据研究条目计算，放射学反应基于麦克唐纳标准。对所有亚组都生成了 Kaplan-Meier 估计值。获得的平均和中位生存期如下：整个组为 34 个月和 29.6 个月；卵巢癌33.6个月和42.3个月；肺腺癌为15.3个月和13.5个月；小细胞肺癌8.3个月和8.8个月；乳腺癌为8.9个月和8.1个月；系统性淋巴瘤脑转移分别为 24.8 个月和 16.3 个月。结论。即使每个亚组中的患者数量较少，所获得的结果对于卵巢癌、肺腺癌、小细胞肺癌和全身性淋巴瘤的多发性脑转移似乎还是有希望的。
BACKGROUND. Cerebral metastases are clinically significant in 10% to 30% of patients with neoplasia. Multiple cerebral metastases are typically treated with palliative radiotherapy There is no consensus on the role of enhanced chemotherapy delivery as an adjuvant treatment modality in this disease. In this report, the authors detailed their experience with intraarterial (IA) chemotherapy infusion with and without blood-brain barrier disruption (BBBD) in patients with multiple cerebral metastases.METHODS. From November 1999 to May 2005, 38 patients with multiple cerebral metastases were enrolled in a prospective study. Patients were treated with IA carboplatin, except for those with cerebral metastases of systemic lymphoma, who were administered IA methotrexate. Osmotic BBBD was offered to patients without the presence of a significant mass effect. These regimens were coupled with intravenous etoposide and cyclophosphainicie. Cycles were repeated every 4 weeks.RESULTS. Survival was calculated from Study entry and radiologic response was based on MacDonald criteria. Kaplan-Meier estimates were generated for all subgroups. Mean and median survival obtained was as follows: 34 and 29.6 months for the whole group; 33.6 and 42.3 months for ovarian carcinoma; 15.3 and 13.5 months for lung adenocarcinomas; 8.3 and 8.8 months for small cell lung carcinoma; 8.9 and 8.1 months for breast carcinoma; and 24.8 and 16.3 months, respectively, for cerebral metastasis from systemic lymphoma.CONCLUSIONS. Even with a small number of patients in each subgroup, the results obtained seem promising for multiple brain metastasis of ovarian carcinoma, adenocarcinoma of lung, small cell lung carcinoma, and systemic lymphoma.