Histopathological findings in autopsied glioblastoma patients treated by mixed neutron beam BNCT
Histopathological findings in autopsied glioblastoma patients treated by mixed neutron beam BNCT
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DOI：
10.1023/b:neon.0000024725.31515.22
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发表时间：
2004-05-01
影响因子：
3.9
通讯作者：
Nakagawa, Y
中科院分区：
文献类型：
--
作者：
Kageji, T;Nagahiro, S;Nakagawa, Y
自1998年以来，我们引入了一种混合的超热和热中子束用于硼中子俘获治疗（BNCT），以改善中子束流分布。16例恶性胶质瘤患者（胶质母细胞瘤，n = 14;间变性室管膜瘤，n = 1; PNET，n = 1）在日本接受BNCT治疗。其中9人死亡; 3例因脑脊液（CSF）播散，1例因肿瘤浸润、脑膜炎、肺炎、不明原因各1例，2例因局部复发或放射性坏死死亡。目前的尸检研究包括3例胶质母细胞瘤患者，他们接受了采用超热中子束和硼帽酸钠（BSH：Na 2B 12 H11 SH）的BNCT治疗。所有患者均未在原发部位出现局部再生长。然而，在2例患者中有CSF播散;肿瘤细胞在整个蛛网膜下腔被识别。在另一名患者中，肿瘤细胞从肿瘤腔底部通过胼胝体和大脑脚大量侵入同侧和对侧半球和脑干。我们的研究结果表明，BNCT可以实现在原发部位的胶质母细胞瘤的局部控制。然而，为了进一步改善BNCT后的临床结果，必须采取措施防止CSF传播。
Since 1998, we have introduced a mixed epithermal- and thermal neutron beam for boron neutron capture therapy (BNCT) to improve the neutron beam distribution. Sixteen patients with malignant glioma (glioblastoma, n = 14; anaplastic ependymoma, n = 1; PNET, n = 1) were treated by BNCT in Japan. Of these, 9 died; 3 due to cerebrospinal fluid (CSF) dissemination, 1 each of tumor invasion, meningitis, pneumonia, and unknown causes, and 2 patients died of local recurrence or radiation necrosis. The current postmortem study is comprised of 3 patients with glioblastoma who were treated with BNCT employing an epithermal neutron beam and sodium borocaptate (BSH: Na2B12H11SH). None of the patients manifested local regrowth at the primary site. However, in 2 patients there was CSF dissemination; tumor cells were recognized throughout the subarachnoid space. In the other patient, tumor cells had massively invaded the ipsilateral- and contralateral hemisphere and brain stem from the bottom of the tumor cavity via the corpus callosum and cerebral peduncle. Our findings indicate that BNCT can achieve local control of glioblastoma at the primary site. However, to further improve the clinical outcome after BNCT, steps must be taken to prevent CSF dissemination.