Journal of Neuro-Oncology

, Volume 36, Issue 2, pp 191–198 | Cite as

Phase II study of intracarotid or selective intracerebral infusion of cisplatin for treatment of recurrent anaplastic gliomas

  • Edward J. Dropcho
  • Steven S. Rosenfeld
  • Jiri Vitek
  • Barton L. Guthrie
  • Richard B. Morawetz
Article

Abstract

Purpose: To assess the response of patients with recurrent malignant gliomas to intra-arterial (IA) cisplatin. Methods: Eligibility criteria included patients with recurrent supratentorial malignant gliomas and measurable, unilateral contrast-enhancing tumor located within the territory of one or two major cerebral arteries. Patients received 75 mg/m2 IA cisplatin every four weeks. Depending on individual patients' tumor topography, cisplatin was infused either into the cervical internal carotid artery (ICA) (15 patients), or into one or two major cerebral arteries (26 patients), most often the M1 segment of the middle cerebral artery. Results: Of 40 patients evaluable for tumor response, four patients (10%) were responders and nine patients (22%) had disease stabilization. The median time to tumor progression among the 13 patients with tumor response or stable disease was 23.7 weeks. The response rate did not significantly differ between patients receiving ICA versus selective intracerebral infusion, although the latter group contained a higher proportion of glioblastoma. Tumor progression occurred solely as local failure in 33 patients (82%), with all enhancing tumor still located within the vascular territory infused with IA cisplatin. Ipsilateral vision loss occurred in two patients after ICA cisplatin but in none of the selective infusion patients. Seizures and/or transient or permanent neurologic deterioration occurred in four patients (27%) after ICA cisplatin and in 11 patients (44%) after selective intracerebral infusion. Conclusions: Although this was not a randomized comparison, selective intracerebral artery cisplatin infusion in this group of patients reduced the risk of eye toxicity, but did not produce a better tumor response rate, and carried a higher risk of neurotoxicity relative to ICA infusion.

glioma cisplatin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dropcho EJ: Intra-arterial chemotherapy for malignant gliomas. In: Berger MS, Wilson CB (eds) Textbook of Gliomas. W.B. Saunders, Cambridge, MA, in pressGoogle Scholar
  2. 2.
    Mahaley MS, Hipp SW, Dropcho EJ, Bertsch L, Cush S, Tirey T, Gillespie GY: Intracarotid cisplatin chemotherapy for recurrent gliomas. J Neurosurg 70: 371–378, 1989Google Scholar
  3. 3.
    Dropcho EJ, Rosenfeld SS, Morawetz RB, Vitek J, Brothers M, Gorum T, Bell S, Gillespie GY, Glantz N, Mahaley NS, Schold SC: Pre-radiation intracarotid cisplatin treatment of newly diagnosed anaplastic gliomas. J Clin Oncol 10: 452– 458, 1992Google Scholar
  4. 4.
    Burger PC: Malignant astrocytic neoplasms: classification, pathologic anatomy, and response to treatment. Semin Oncol 13 (March): 16–26, 1986Google Scholar
  5. 5.
    Mahaley MS, Gillespie GY, Hammett R: Computerized tomography brain scan tumor volume determinations. J Neurosurg 72: 872–878, 1990Google Scholar
  6. 6.
    Newton HB, Page MA, Junck L, Greenberg HS: Intra-arterial cisplatin for the treatment of malignant gliomas. J Neuro-Oncol 7: 39–45, 1989Google Scholar
  7. 7.
    Stewart DJ, Belanger JM, Grahovac Z, Curuvija S: Phase I study of intracarotid administration of carboplatin. Neurosurgery 30: 512–517, 1992Google Scholar
  8. 8.
    Feun LG, Wallace S, Stewart DJ: Intracarotid infusion of cis-diamminedichloroplatinum in the treatment of recurrent malignant brain tumors. Cancer 54: 794–799, 1984Google Scholar
  9. 9.
    Bobo H, Kapp JP, Vance R: Effect of intra-arterial cisplatin and BCNU dosage on radiographic response and regional toxicity in malignant glioma patients: proposal of a new method of intra-arterial dosage calculation. J Neuro-Oncol 13: 291–299, 1992Google Scholar
  10. 10.
    Nakagawa H, Fujita T, Kubo S, Tsuruzono K, Yamada M: Selective intra-arterial chemotherapy with a combination of etoposide and cisplatin for malignant gliomas: preliminary report. Surg Neurol 41: 19–27, 1994Google Scholar
  11. 11.
    Recht L, Fram RJ, Strauss G, Fitzgerald TJ: Preirradiation chemotherapy of supratentorial malignant primary brain tumors with intracarotid cis-platinum and IV BCNU. Am J Clin Oncol 13: 125–131, 1990Google Scholar
  12. 12.
    Junck L, Koeppe RA, Greenberg HS: Mixing in the human carotid artery during carotid drug infusion studied with PET. J Cerebral Blood Flow Metab 9: 681–689, 1989Google Scholar
  13. 13.
    Saris SC, Blasberg RG, Carson RE, De Vroom HL: Intravascular streaming during carotid artery infusions: demonstration in humans and reduction using diastole-pulsatile administration. J Neurosurg 74: 763–772, 1991Google Scholar
  14. 14.
    Aoki S, Terada H, Kosuda S, Shitara N, Fujii H: Supraophthalmic chemotherapy with long tapered catheter: distribution evaluated with intraarterial and intravenous Tc-99m HMPAO. Radiology 188: 347–350, 1993Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Edward J. Dropcho
    • 1
  • Steven S. Rosenfeld
    • 2
  • Jiri Vitek
    • 3
  • Barton L. Guthrie
    • 4
  • Richard B. Morawetz
    • 4
  1. 1.Department of NeurologyIndiana University Medical Center and The Richard Roudebush Veterans Affairs Medical CenterIndianapolisUSA
  2. 2.Department of NeurologyUniversity of Alabama atBirminghamUSA
  3. 3.Radiology (Neuroradiology)University of Alabama at BirminghamUSA
  4. 4.Surgery (Neurosurgery)University of Alabama at BirminghamUSA

Personalised recommendations