Convection-enhanced delivery in the treatment of malignant glioma
Convection-enhanced delivery in the treatment of malignant glioma
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DOI：
10.1179/016164106x116836
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发表时间：
2006-07-01
影响因子：
1.9
通讯作者：
Bruce, Jeffrey N.
中科院分区：
文献类型：
--
作者：
Lopez, Kim A.;Waziri, Allen E.;Bruce, Jeffrey N.
尽管神经胶质瘤治疗取得了进展，但由于切除后快速复发，中位生存率仍然很低。解决局部侵袭的区域药物输送方法可能会改善临床结果。对流增强输送 (CED) 是一种新型疗法，可通过正压输注将物质分布到整个间质。使用各种药物的研究调查了影响 CED 的参数，包括输注速率、插管尺寸、输注体积、细胞外空间、颗粒特征和肿瘤组织结构。我们回顾了使用通过 CED 施用的不同物质成功治疗的小动物神经胶质瘤模型，特别是我们在 C6 大鼠神经胶质瘤模型中使用拓扑替康的良好结果。我们还回顾了利用 CED 的 I/II 期试验，这些试验显示出有希望的反应率和可接受的安全性。未来的研究应包括前瞻性临床试验和对全身给药无效的新型抗肿瘤药物的研究。大型动物神经胶质瘤模型的开发将加强 CED 的临床前研究。在临床上，同样应该探索监测治疗药物分布和实时患者反应的方法。
Despite advancements in glioma therapy, median survival remains low because of rapid post-resection recurrence. A regional method of drug delivery to address local invasion may improve clinical outcomes. Convection-enhanced delivery (CED) is a novel therapy that allows distribution of substances throughout the interstitium via positive-pressure infusion. Studies using various agents have investigated the parameters that affect CED including infusion rate, cannula size, infusion volume, extracellular space, particle characteristics and tumor tissue structure. We review models of small animal glioma that have been successfully treated using different substances administered through CED, particularly our favorable results using topotecan in a C6 rat glioma model. We also review Phase I/II trials utilizing CED which have shown promising response rates and acceptable safety profiles. Future studies should include prospective clinical trials and investigation of novel antitumor agents that are ineffective with systemic delivery. Development of a large animal glioma model would enhance preclinical investigation of CED. Clinically, methods to monitor distribution of therapeutic agents and real-time patient response should likewise be explored.