FEASIBILITY STUDY OF INTRAARTERIAL VS INTRAVENOUS CISPLATIN, BCNU, AND TENIPOSIDE COMBINED WITH SYSTEMIC CISPLATIN, TENIPOSIDE, CYTOSINE-ARABINOSIDE, GLYCEROL AND MANNITOL IN THE TREATMENT OF PRIMARY AND METASTATIC BRAIN-TUMORS

Sixteen patients with intracerebral tumors received intraarterial cisp latin, teniposide, and BCNU combined with intravenous cisplatin, tenip oside, and cytosine arabinoside. Oral glycerol and intravenous mannito l were given along with the intravenous chemotherapy in an attempt to increase drug delivery to tumor by augmenting tumor blood flow. Thirte en additional patients were treated with the same regimen, but receive d all the chemotherapy intravenously. Of the 16 patients receiving int raarterial chemotherapy (median survival, 14 weeks),none responded, 5 (31%) were stable for > 8 weeks, 8 (50%) failed, and 3 (19%) were unev aluable due to early death. Of the 13 patients receiving all their tre atment intravenously (median survival, 13 weeks), 3 (23%) responded, 1 (8%) was stable, 7 (54%) failed, and 2 (15%) were unevaluable due to early death. In the patients receiving intraarterial chemotherapy, tox icity included ipsilateral retinal toxicity (2 patients), ocular pain or headache (10), periorbital swelling and flushing (6), increased bra in edema with focal neurological deficits and drowsiness (5), and cath eter-related carotid artery thrombosis followed by fatal herniation (1 ). Myelosuppression was worse in patients who received all their treat ment intravenously than in those receiving intraarterial chemotherapy (p < 0.05). Neutropenic sepsis developed in 4 patients on the intraart erial arm (1 fatal) and in 5 patients on the intravenous arm (2 fatal) . Other toxic effects were similar whether or not patients received in traarterial treatment or only intravenous treatment. Overall, toxicity of this regimen was excessive, and response rates were lower than wou ld have been expected with single agent therapy.