Efficacy of intratumoral delivery of mitoxantrone in recurrent malignant glial tumours

Ninety-nine patients bearing recurrent malignant glioma sequentially select ed according to strict eligibility criteria (72 GBL and 27 AA) entered the study. All patients were previously managed with radiotherapy 60 Gy total d ose and chemotherapy with nitrosoureas and platinum compounds. At recurrenc e they were subdivided in homogeneous groups, all treated with the same sys temic chemotherapy protocol: 27 GBL (group A) only systemically treated, 20 GBL (group B) treated also locally by delivering 4 mg of mitoxantrone ever y 20 days through the Ommaya reservoire, and 25 GBL (group C) treated with a second surgery and locally as group B. Of the AA group, 13/27 were treate d locally trough the Ommaya reservoir after repeat surgery. A trend to different demographic features among subgroups (with locoregiona lly treated patients and patients undergoing repeat surgery being younger t han the others) was seen in this non-randomized study, but this was not sta tistically significant. Median overall survival was 27, 26 and 15.5 months respectively for groups c, b and a (log-rank = 0.1). After tumor recurrence median survival was 16. 8, 12 and 6.6 months respectively for groups c, b and a (log-rank = 0.001) For the 29 AA, overall survival was 48.5 and 100 months (log-rank = 0.03) i f treated locally with second tumor debulking. Our results stress the opini on that a second operation could be indicated only if it is a part of a the rapeutic protocol to allow a locoregional treatment. Moreover we can finally assume that local delivery of chemotherapy after tu mor recurrence, possibly extends patients survival but certainly improves t he number of long-survivors.