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 11 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 <1 to 40 months. The median survival from the time of diagnosis was 27 months, ranging from 7 to 80 months. The median survival time from the first BBBD or intraarterial treatment was 16.5 months, ranging from 5 to 69 months. One patient was lost to follow-up with an unknown date of death. Although the sample size is small, the
TTP and survival times are longer than those previously reported in other DPG series. In addition, the ability to demonstrate stable disease or partial responses in DPG on MR imaging argues for the therapeutic benefit of BBBD
chemotherapy. The enhanced delivery of
chemotherapy afforded by osmotic BBBD supports the further examination of this treatment modality for patients with DPG.