Intra-arterial ACNU chemotherapy employing 20% mannitol osmotic blood-brain barrier disruption for malignant brain tumors.

Abstract

The clinical effects and problems of intra-arterial water-soluble antitumor nitrosourea (ACNU) therapy following osmotic blood-brain barrier modification are discussed. Twenty-one patients with malignant brain tumors were divided into two groups. Group 1 consisted of 16 patients treated by operation, irradiation, and two or more courses of intracarotid infusion of ACNU 100 mg/body (1.7-2.2 mg/kg) following 20% mannitol 200 ml (1.3-1.6 ml/sec) (7 grade 4 astrocytomas, 5 grade 3 astrocytomas, and 4 others). Group 2 consisted of five patients treated by operation, irradiation, and repeated intracarotid infusion of ACNU 100 mg/body alone (grade 4 astrocytoma). The 2-year survival rate in Group 1 was 79% (11 of 14 cases followed up for longer than 2 years) and the 3-year survival rate was 67%. Five of seven grade 4 astrocytoma patients (71%) in Group 1 survived for more than 1 year 6 months, whereas four of five grade 4 astrocytoma in Group 2 died within 1 year 6 months. The measurement of the ACNU concentration in tumor tissues and blood in 11 brain tumors, after intracarotid infusion of ACNU with blood-brain barrier disruption, showed peak values in the tumor tissues of 3.02-32.53 micrograms/gm (mean, 9.67 micrograms/gm), about three to five times as high as that in blood in most cases. This method used in Group 1 appears to be relatively safe without permanent neurological deficits and offers a potential therapeutic effect when used in combination with appropriate premedication in suitable patients.

• Authors: M Miyagami, T Tsubokawa, M Tazoe, Y Kagawa
• Journal: Neurologia medico-chirurgica (Neurol Med Chir (Tokyo)) Vol. 30 Issue 8 Pg. 582-90 (Aug 1990) ISSN: 0470-8105 [Print] Japan
• PMID: 1703636 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Nimustine
• Mannitol

Topics

• Adolescent
• Adult
• Aged
• Blood-Brain Barrier (drug effects)
• Brain Neoplasms (diagnostic imaging, drug therapy, physiopathology)
• Child
• Electroencephalography
• Female
• Glioblastoma (diagnostic imaging, drug therapy, physiopathology)
• Humans
• Infusions, Intra-Arterial
• Male
• Mannitol (administration & dosage, adverse effects, therapeutic use)
• Middle Aged
• Nimustine (administration & dosage, adverse effects, therapeutic use)
• Osmotic Pressure
• Tomography, X-Ray Computed