H. Nakagawa et al., SELECTIVE INTRAARTERIAL CHEMOTHERAPY WITH A COMBINATION OF ETOPOSIDE AND CISPLATIN FOR MALIGNANT GLIOMAS - PRELIMINARY-REPORT, Surgical neurology, 41(1), 1994, pp. 19-27
We administered selective intra-arterial chemotherapy consisting of a
combination of etoposide and cisplatin to 20 patients with malignant g
lioma (seven with recurrent and six with enlarged tumors after initial
treatment, and seven newly diagnosed patients). Evaluation of efficac
y was based on computed tomographic and magnetic resonance imaging fin
dings. In the process of establishing a safe technique for superselect
ive intra-arterial chemotherapy, we encountered cerebrovascular accide
nts in two patients (after etoposide in one and after etoposide plus c
isplatin in the other). In these two cases, 100 mg/m2 of etoposide and
100 mg/m2 of cisplatin were delivered via the horizontal segment of t
he middle cerebral artery (M1) or the tip of the basilar artery, with
the infusion time reduced to 20 minutes. Thereafter, the etoposide was
diluted, and the doses of both drugs were reduced to 80 or 50 mg/m2,
and finally to 60 mg/m2, and both were infused over 60 minutes. In add
ition, for prevention of local spasm, papaverine hydrochloride and nic
ardipine were given via the same catheter at 5-minute intervals during
administration of etoposide and cisplatin. No complications developed
in the later cases. Thereafter, selective intra-arterial infusion of
etoposide and cisplatin into the anterior cerebral artery, middle cere
bral artery, posterior cerebral artery, or the basilar artery for mali
gnant gliomas in the basal ganglia, internal capsule, and brainstem-a
procedure generally considered risky in terms of potential complicatio
ns-was performed safely, with tolerable side effects. Computed tomogra
phy and magnetic resonance imaging indicated improvement in 13 patient
s, including four whose tumors completely disappeared. This method of
intraarterial chemotherapy may be useful as an adjuvant treatment for
malignant glioma.