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Supraophthalmic carotid infusion for recurrent glioma rationale technique and preliminary results for cisplatin and 1 3 bis 2 chloroethyl 1 nitrosourea


Journal of Neuro-Oncology 3(1): 5-12
Supraophthalmic carotid infusion for recurrent glioma rationale technique and preliminary results for cisplatin and 1 3 bis 2 chloroethyl 1 nitrosourea
The chemotherapeutic agents 1-3 bis(2-chloroethyl)-1-nitrosourea (BCNU) and cis-diamminedichloroplatinum (II) (cisplatin) have both shown activity against malignant glioma, especially when given by arterial infusion. The combination of these agents given by this method is logical because their individual major toxicities are directed at different organ systems and differences in restriction by the blood-brain barrier. Both agents are toxic to the eye and infusion of both agents simultaneously into the internal carotid artery would deliver doses of the drug to the eye which should be associated with an unacceptable level of ocular toxicity. A technique was developed utilizing a flexible flow-directed catheter with a tip which is manipulated by hydraulic forces for delivery of the drug into the intracranial carotid artery above the origin of the ophthalmic artery, thus sparing the eye from the high concentration of drug during the 1st pass through the arterial circulation. In 13 patients with recurrent malignant glioma treated by arterial infusion of both agents (cisplatin 150-200 mg, BCNU 300 mg fixed dose), there has been no damage to the ipsilateral eye. Preliminary results of treatment appear to be good, with definite tumor regression following arterial infusion in 10 of 12 radiographically evaluable cases. Median survival to date is 11 mo. with 3 patients still surviving. The longest survival is 24 mo. The supraophthalmic infusion technique protects the eye and the combination of drugs given by arterial infusion produces a high tumor response rate.

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Accession: 006546107



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