악성 뇌종양에서 Gliadel® Wafer의 효용성；예비 보고

Abstract

Introduction：Adjuvant systemic chemotherapy increases survival for malignant glioma patients. However, it is unable to effectively cross the blood-brain barrier and have unacceptable systemic toxicities, and the short exposure time of tumor tissue to chemotherapeutic agents. Consequently, many researchers have tried to develop innovative local treatments that bypass the blood-brain barrier and allow for direct treatment in the central nervous system(interstitial chemotherapy). Recently, Gliadel® wafer containing carmustine(BCNU) was approved for the interstitial chemotherapy. We present our initial experience in using interstitial chemotherapy as a strategy to treat malignant brain tumors.

Materials and Methods：We analyzed the clinical feature, MRI figures, KPS score, and progression-free survival in 13 malignant brain tumor patients treated with interstitial chemotherapy using Gliadel® wafer from Sep 2004 to Dec 2006. There were 6 glioblastomas, 4 anaplastic astrocytomas, and 3 poorly differentiated carcinomas. Each patient has different treatment histories before and after insertion of Gliadel® wafer. Out of 3 metastatic brain tumors, 2 were recurred after gamma knife surgery. Old patient with huge cystic metastatic tumor refused other kind of chemotherapy. So we inserted Gliadel® wafer after grossly total removal of tumor without any other treatment. Three anaplastic astrocytomas and three glioblastomas recurred after surgery or biopsy, followed by concomitant radiation and Temodal chemotherapy. Three glioblastomas and one anaplastic astrocytoma were treated with interstitial chemotherapy using Gliadel® wafer at the first surgery followed by concomitant radiation and Temodal® chemotherapy.

Results：There was not any complication related to interstitial chemotherapy using Gliadel® wafer during follow-up (follow up duration：mean - 10 months, range -3~20 months). Three patients were dead 8, 11 and 12 months after after insertion of Gliadel® wafer(2 anaplastic astrocytomas and 1 glioblastoma). Follow-up MRI of 2 glioblastoma patients revealed tumor regrowth 3 and 19 months after insertion of Gliadel® wafer. The others are alive. The survivals showed the good performance status.

Conclusion：This would be the brief preliminary report about the local control of the highly infiltrative brain tumor. Because the local progression or recurrence is still problematic combination of interstitial chemotherapy using Gliadel® wafer and systemic chemotherapy with Temodal® or other anticancer agents could improve patient's survival without increasing additional systemic toxicity.