VENTRICULOLUMBER PERFUSION OF YRIMIDINYL)METHYL]-1-(2-CHLOROETHYL)-1-NITROSOUREA HYDROCHLORIDE FOR SUBARACHNOID DISSEMINATION OF GLIOMAS

The toxicity and therapeutic effect of the ventriculolumber perfussion of yrimidinyl)methyl-1-1(2-chloroethyl)-1-nitrosourea hydrochloride ( ACNU) against subarachnoid dissemination of gliomas were studied. Twen ty-one patients (6 patients with anaplastic glioma, 7 with glioblastom a and 8 with medulloblastoma or PNET) received ventriculolumber perfus ion of ACNU when they were diagnosed as having subarachnoid disseminat ion. The course of perfusion and cumulative dose of ACNU was 10 times and 95 mg on average, respectively. Most of the patients received syst emic chemotherapy in combination with perfusion therapy and some patie nts with radiotherapy. Response rate was 17% and median survival time after the diagnosis of dissemination was 12 months for anaplastic glio mas, 29% and 12 months for glioblastoma, and 88% and over 25 months fo r medulloblastoma and PNET The ventriculolumber perfusion of ACNU was performed for prophylactic purpose in 7 patients with high risk at the early postoperative period in combination with conventional adjuvant therapy. The course of perfusion and cumulative dose of ACNU was 2.3 t imes and 21 mg on average, respectively. One patient developed subarac hnoid dissemination and died 22 months after surgery. Other 6 patients survived without dissemination on median over 29 months after surgery . Side effects encountered were headache in 4 patients, nausea and vom iting in 5, a convalsion in 2, right facial weakness in 1, fecal incon tinence in 3 and meningitis in 2. They were all temporary except for f acial weakness occurred in one patient. These data suggest that the ve ntriculolumber perfusion of ACNU is a safe and useful in the treatment and prophylaxis against the subarachnoid dissemination of gliomas.