Pre-irradiation internal carotid artery BCNU in treatment of glioblastoma multiforme.

Abstract

High-dose 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) infusion into the internal carotid artery following cranial irradiation in the treatment of glioblastoma multiforme is accompanied by evidence of leukoencephalopathy in a significant number of patients. In an attempt to avoid this problem, a phase I trial was performed using intracarotid BCNU infusion before irradiation. Twenty-eight patients with grade III/III astrocytoma (World Health Organization Classification, equivalent to Kernohan grade IV) received a 400-mg infusion of BCNU into the infraophthalmic carotid artery. The treatment was repeated every 4 weeks for a total of four cycles prior to cranial irradiation (5500 to 6000 cGy). The major toxic sequelae included nausea and vomiting (24%), decreased visual acuity (14%), transient cerebral ischemia (3.5%), and thrombocytopenia (3.5%). Fatal leukoencephalopathy occurred in two patients. The median survival time was 37 weeks for all evaluable patients and 56+ weeks for those completing the protocol. The tumor response to drug infusion as judged by computerized tomography (CT) was complete in 22% of patients and partial in 22%; 56% showed no CT tumor response. Pre-irradiation intracarotid artery BCNU benefits a very small group of patients with grade III/III astrocytoma. The associated severe leukoencephalopathy makes this mode of therapy unacceptable for a phase III trial.

• Authors: R Bashir, F H Hochberg, R M Linggood, K Hottleman
• Journal: Journal of neurosurgery (J Neurosurg) Vol. 68 Issue 6 Pg. 917-9 (Jun 1988) ISSN: 0022-3085 [Print] United States
• PMID: 2836567 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Carmustine

Topics

• Adult
• Brain Diseases (chemically induced, diagnostic imaging)
• Brain Neoplasms (drug therapy, mortality, radiotherapy)
• Carmustine (administration & dosage, adverse effects, therapeutic use)
• Carotid Artery, Internal
• Combined Modality Therapy
• Female
• Glioblastoma (drug therapy, mortality, radiotherapy)
• Humans
• Infusions, Intra-Arterial
• Middle Aged
• Pilot Projects
• Thrombocytopenia (chemically induced)
• Tomography, X-Ray Computed