TERAPIA ENDOARTERIOSA SUPERSELETTIVA CON CARBOPLATINO (FASE I E II) NEI TUMORI PRIMITIVI E SECONDARI DEL SISTEMA NERVOSO CENTRALE

From February 1990 to 31 December 1991, 36 patients affected by primitive or secondary tumour of the central nervous system were treated with the selective endarterial therapy with Carboplatin: 19 males and 17 females, whose average age was 53.4 years. There were 26 cerebral primitive tumours (17 multiform glioblastomas and 9 anaplastic astrocytomas) and 10 cerebral metastases. Angiography was based on the use of a 5 F catheter femorally inserted into the internal carotid artery, which was rapidly followed by the insertion of the 2.2 F catheter in the terminal portion of the carotid siphon downstream of the origin of the ophthalmic artery; in the case of marked tortuosity of arterial vessles, the catheter was inserted into the internal carotid artery of the neck. 1 to 6 sessions per patient were performed. Endarterial chemotherapy was based on the selective infusion of Carboplatin, diluted in 250 cc of physiological solution over a period of 30 min. The Carboplatin dosage by systemic administration in association with other drugs was 100, 150 and 200 mg every 28 days (in the first 8 patients), while in monochemotherapy it was 200 to 500 mg every 2 weeks (remaining 28 patients). As regards the toxicity of this drug, 2 cases of hemiparesis were observed, which regressed two hours after treatment, probably ascribable to angiography complications. No cases of neurologic or eye toxicity were found. In one case, flebitis of the homolateral lower limb developed and in the two patients leukopenia and 2nd-degree nausea were observed, with Carboplatin doses of 500mg. 32 out of 36 patients were evaluated, since in four of them progression started after one cycle of endarterial chemotherapy, leading to death shortly after. These are the responses of the 7 patients who underwent endarterial therapy in association with systemic therapy: in the presence of glioblastoma there were 2 stabilizations of the disease (SD), 1 partial remission (PR) and 1 progression (PRO); in astrocytomas there were 2 partial responses and 1 progression. In the 18 patients affected by primitive cerebral neoplasia who underwent the endarterial therapy with Carboplatin only, a 41.6% response was obtained (4 SD + PR), while in astrocytomas the response reached 83.3% considering the responses altogether (3 SD + 2 PR). In the 7 cerebral metastases, the responses were as follows: 5 SD, 1 PR, 1 PRO. From the point of view of peculiar CT findings, we noticed that in serial controls a structural neoplasia variation could be observed, with an increase of the hypodense, colliquative component and with smaller perilesional edema. A further finding concerned the appearance of minute parenchymal calcifications. In 18 patients affected by primitive cerebral neoplasias, the overall response reached 55.5% (10 cases, 7 SD and 3 PR), with a better quality of life in partial responses and no clinical worsening in the stabilizations of the disease. Toxicity was negligible.