Superselective intra-arterial carboplatin for treatment of intracranial neoplasms: experience in 100 procedures

Background: The results of animal studies suggest that superselective intra -arterial infusion allows the permeation of a high concentration of chemoth erapeutic agents within intracranial neoplasms. In the present report, we r eview our clinical experience with the 100 intra-arterial infusions of carb oplatin in intracranial neoplasms not responsive to other treatment modalit ies. Methods: Carboplatin was infused in 100 separate sessions (24 patients) as a mean dose of 286 +/- 60 mg/m(2) (range 34-377 mg/m(2)). RMP-7, a bradykin in analog, was used as an adjunct in 28 sessions (6 patients). The infusion s were performed through superselective microcatheterization of the followi ng arteries: internal carotid (n = 39), middle cerebral (n = 61), posterior cerebral (n = 21) and anterior cerebral (n = 10). The frequency of neurolo gical and non-neurological complications, and survival were recorded. In a subset of 10 patients, tumor volume was measured by serial magnetic resonan ce images to assess therapeutic response to therapy. Results: The mean age of the patients was 44.5 years (range 26-67 years); 1 3 were men. The tumors were classified as glioblastoma multiforme (n = 12), metastatic turner (I? = I), high-grade astrocytoma (n = 6), and anaplastic mixed glioma (n = 5). Follow-up was available fur 23 patients (mean 22 mon ths, range 2-69 months). Survival beyond 1 year after initiation of intra-a rterial carboplatin therapy was documented in 12 of the 23 patients. A tota l of 13 neurological complications including seizures (n = 7), transient ne urological deficits (n = 5), and ischemic stroke (n = 1) were observed in 1 00 procedures. A lower frequency of complications occurred in men and in pa tients who received adjunctive RMP-7. Volumetric analysis of serial magneti c resonance images demonstrated tumor mass reduction in 3 out of 10 patient s. An increase in tumor mass ranging from 23% to 230% was observed in the o ther 7 patients over a period ranging from 2.3 to 37.7 months since initiat ion of carboplatin therapy. Conclusions: Superselective intra-arterial administration of carboplatin ap pears feasible and was associated with predominantly transient neurological complications. The addition of RMP-7 to carboplatin therapy appears to be at least as safe as the administration of carboplatin alone and requires fu rther investigation as a means of chemotherapeutic dose intensification.