Osmotic blood-brain barrier disruption chemotherapy for diffuse pontine gliomas
Osmotic blood-brain barrier disruption chemotherapy for diffuse pontine gliomas
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DOI：
10.1007/s11060-005-9038-4
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发表时间：
2006-05-01
影响因子：
3.9
通讯作者：
Neuwelt, Edward A.
中科院分区：
文献类型：
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作者：
Hall, Walter A.;Doolittle, Nancy D.;Neuwelt, Edward A.
弥漫性脑桥胶质瘤（DPG）患者的预后仍然很差。治疗这种疾病需要新的积极创新疗法。从 1984 年到 1998 年，8 名 DPG 患者（4M/4F），中位年龄为 11 岁，每月接受渗透性血脑屏障破坏（BBBD）化疗，使用动脉内卡铂或甲氨蝶呤以及静脉注射环磷酰胺和依托泊苷。患者出现颅内压升高、长束征、复视、共济失调和恶心/呕吐的中位持续时间为 6 周。 DPG 在 7 名患者的磁共振 (MR) 成像和 1 名患者的 CT 上得到证实。两名患者的活检显示星形细胞瘤和间变性星形细胞瘤。给予对比剂后，三个肿瘤在 MR 成像上增强。三名患者在 BBBD 化疗之前接受了放射治疗，四名患者在 BBBD 化疗之后接受了放射治疗。两名患者在 BBBD 化疗前接受了化疗（他莫昔芬、拓扑替康），另外两名患者在 BBBD 化疗后接受了化疗。一般来说，患者每 3 个月接受一次 MR 成像评估，以监测治疗反应。采用 BBBD 的化疗周期中位数为 10 个，平均为 10 个。三名患者还接受了 1 个、2 个或 3 个周期的动脉内化疗（不使用 BBBD）。一名开始使用卡铂的患者转换为甲氨蝶呤，五名开始使用甲氨蝶呤方案的患者后来转换为卡铂。一名患者每月接受甲氨蝶呤治疗，随后接受 14 天的丙卡巴肼治疗，另一名患者开始接受甲氨蝶呤治疗，后来改用长春滨。磁共振成像显示两名部分缓解，五名患者疾病稳定，一名患者疾病进展。肿瘤进展的中位时间为 15 个月，范围为
The prognosis for patients with diffuse pontine gliomas (DPG) remains poor. New aggressive innovative treatments are necessary to treat this disease. From 1984 to 1998, eight patients (4M/4F), median age I I years, with DPG were treated with monthly osmotic blood-brain barrier disruption (BBBD) chemotherapy using intraarterial carboplatin or methotrexate and intravenous cytoxan and etoposide. Patients presented for a median duration of 6 weeks with increased intracranial pressure, long tract signs, diplopia, ataxia, and nausea/vomiting. DPG was demonstrated on magnetic resonance (MR) imaging in seven patients and on CT in one. Two patients had biopsies that showed an astrocytoma and an anaplastic astrocytoma. Three tumors enhanced on MR imaging after contrast administration. Three patients had radiation therapy before BBBD chemotherapy and four afterwards. Two patients had chemotherapy (tamoxifen, topotecan) before BBBD chemotherapy and two afterwards. In general, patients were evaluated with MR imaging every 3 months to monitor for a response to treatment. The median number of chemotherapy cycles that were administered by BBBD was 10, mean 10. Three patients also received one, two, or three cycles of intraarterial chemotherapy without BBBD. One patient that was started on carboplatin was converted to methotrexate, and five that were started on the methotrexate protocol were later converted over to carboplatin. One patient received monthly methotrexate followed by 14 days of procarbazine and one patient started on methotrexate was switched to navelbine. MR imaging demonstrated two partial responses, five patients with stable disease, and one with disease progression. The median time to tumor progression was 15 months with the range from