Glioblastoma multiforme (GBM) makes up as many as 30% of all primary brain tumors. Despite the employment of multimodal antitumor treatment, the overall survival is less than one year. Between 06/01/1998 and 06/01/2000 17 patients (Group A) with GBM (11 males, 6 females; median age 54.3 years) were administered local chemotherapy with cisplatin incorporated into biodegradable 6-carboxylcellulose polymer (cisplatin-depot (CDDP-D)). After the subtotal removal of GBM, twenty 1.5 x 1.5 cm polymer plates with a total area of 45 cm2 (the density of cisplatin immobilization on 6-carboxylcellulose being 1 mg/cm2, a total cisplatin dose of 45 mg) were implanted into the tumor bed. Group B (21 patients with GBM; 11 males, 10 females; median age 53.2 years) was control: the subtotal tumor ablation without CDDP-D implantation. Two to three weeks after the surgery all the patients of Groups A and B started a course of radiation therapy. A total dose of cranial irradiation was 20 Gy (1 fraction/day, 5 days/week; a daily dose of 2 Gy) followed by a boost tumor bed irradiation (1 fraction/day, 5 days/week; a daily dose of 2 Gy) up to the conventional dose of 60 Gy. Survival data for the patients were processed using the Kaplan-Meier method and analyzed by logrank test. All the patients of Group A tolerated surgical ablation of the brain tumor without side effects (brain edema, seizures, etc.). No patient of Group A had a reduction in blood cell counts during six weeks that would indicate systemic exposure to cisplatin. Blood chemistry and urinalysis did not show evidence of renal injury. No side effects of radiotherapy were registered in Group B either, regarding both the psychoneurological status of the patients and the basic values of homeostasis. Karnofsky performance scale (KPS) score of Group A and Group B patients demonstrated no significant differences before and after the surgery. The median overall survivals for patients of Group A and Group B were 427.5 and 211.0 days respectively (p = 0.00001; overall logrank test). Conclusion. Local chemotherapy of GBM with CDDP-D followed by irradiation is well tolerated and effective.
Relevance. The problem of effective prevention and treatment of traumatic brain injuries (TBI) of various etiologies has not been resolved in all countries of the world. Primary brain damage from trauma initiates secondary damage to the nervous tissue. As a result, the interaction of brain neural networks is disrupted and the control of somatic and visceral functions of the body is weakened. The article is based on our own clinical observations and comparison of results with literature data and provides a discussion of the prospects for the use of cell technologies in the prevention of fatal disorders of vital functions control in traumatic brain injuries. Objective. To evaluate the effectiveness of intranasal perineural implantation of mesenchymal stem cells (MSCs) in the complex therapy of patients with TBI. Materials and methods. The technique intranasal perineural administration of MSCs was used in complex therapy of 15 patients with severe TBI. The patients were 19÷69 years old, 13 men and two women. A cell suspension was isolated from the adipose tissue of the patient's abdominal wall and centrifuged for 10 min at 1500 rpm. The cell pellet was washed in phosphate buffered saline and DMEM. Cells were cultured in plastic culture flasks in a humidified atmosphere with 5% CO2 content. The cell mass was trypsinized according to standard technique and resuspended in physiological saline on the day of implantation. Dynamics of culture growth, pluripotency, phenotyping of MSCs were monitored. MSCs were injected under general anesthesia into the submucosa of the nasal cavity 3-4 times with an interval of 3-7 days, depending on the growth rate of MSCs, in a single dose from 12.0×106 to 35.0×106 cells. Results. The use of allogeneic and predominantly autologous MSCs of adipose tissue in the complex treatment of patients with severe TBI by intranasal perineural delivery to the area of traumatic brain injury does not cause complications and is a safe technique. 8 patients with severe TBI showed from 4 to 7 points according to the Glasgow Outcome Scale Extended, with an average of 5.4±1.1 points after 6 months. The main result is that complex therapy, including intranasal implantation of MSCs in acute and subacute periods of severe TBI, contributes to the survival of patients and restoration of neurological – including cognitive – functions control. Conclusions. The effectiveness of intranasal perineural implantation of MSCs in the complex therapy of patients with TBI has been demonstrated. The mechanisms of the beneficial effects of perineural implantation of MSCs in patients with TBI require further research.
Ðåñïóбëèêàíñêèé íàóчíî-ïðàêòèчåñêèé öåíòð íåâðîëîãèè è íåéðîхèðóðãèè, Бåëîðóññêàÿ ìåäèöèíñêàÿ àêàäåìèÿ ïîñëåäèïëîìíîãî îбðàçîâàíèÿ, ÍИИ îíêîëîãèè è ìåäèöèíñêîé ðàäèîëîãèè èì. Í. Í. Àëåêñàíäðîâà, ã. Ìèíñê, БåëàðóñьÇà ïåðèîä ñ 2001 ïî 2007 ã. ñîâмåñòíîé бðèãàäîé íåéðîхèðóðãîâ, îíêîëîãîâ è ïëàñòèчåñ-êèх хèðóðãîâ îïåðèðîâàí 51 бîëüíîé ïî ïîâîäó êðàíèîфàöèàëüíых îïóхîëåé, â òîм чèñëå 28 -äîбðîêàчåñòâåííых, 23 -зëîêàчåñòâåííых. Пåðâèчíîå хèðóðãèчåñêîå âмåшàòåëüñòâî ïðîèзâåäåíî 14 (61%) бîëüíым, ïîâòîðíыå -9 (39%). Бëîê-ðåзåêöèя îñóщåñòâëåíà ó 17 (74%) бîëüíых. Пðîâåäåí ñðàâíèòåëüíыé àíàëèз ïîêàзàòåëåé âыaeèâàåмîñòè бîëüíых ñ êðàíèîфà-öèàëüíымè îïóхîëямè.  òåчåíèå 5 ëåò ñ ðåöèäèâàмè è бåз íèх aeèëè 53% ïàöèåíòîâ, 3 ëåò бåз ðåöèäèâîâ -31,2%, 5 ëåò -21,8%.Кëючåâыå ñëîâà: опухоли основания черепа, хирургия основания черепа, краниофациальная резекция.Êðàíèîфàöèàëüíыå îïóхîëè -эòî íîâîîбðà-зîâàíèя, ðàñïðîñòðàíяющèåñя íà ïåðåäíèå îòäåëы îñíîâàíèя чåðåïà, îêîëîíîñîâыå ïàзóхè, ãëàзíèöó, ïîëîñòü ðòà, íîñîâóю чàñòü ãëîòêè, âåðхíюю чåëюñòü.  ëàòåðàëüíых îòäåëàх îíè ðàñïðîñòðàíяюòñя íà êðыëîíåбíóю è ïîäâèñîчíóю ямêè. Âыäåëåíèå ãðóïïы îïóхîëåé ëèöåâîãî è мîзãîâîãî чåðåïà îбóñ-ëîâëåíî àíàòîмî-òîïîãðàфèчåñêèмè îñîбåííîñòямè, êîòîðыå ðåãëàмåíòèðóюò хèðóðãèчåñêèå äîñòóïы è îïðåäåëяюò ïîñëåäîâàòåëüíîñòü âыïîëíåíèя хèðóð-ãèчåñêèх мàíèïóëяöèé [5,11,20].  íàñòîящåå âðåмя êðàíèîфàöèàëüíыå îïóхîëè â зàâèñèмîñòè îò хàðàê-òåðà è íàïðàâëåíèя ðîñòà ðàзäåëяюò íà ãðóïïы. 1. Çëîêàчåñòâåííыå эêñòðàêðàíèàëüíыå îïóхîëè, ðàñïðîñòðàíяющèåñя â ãëàзíèöó è ïîëîñòü чåðåïà, èñхîäíîå мåñòî ðîñòà -эïèòåëèé îêîëîíîñîâых ïàзóх, ñëåзíых è ñëюííых aeåëåз, мышåчíàя òêàíü (îêîëî 3 % зëîêàчåñòâåííых íîâîîбðàзîâàíèé ãîëîâы è шåè, â 15% íàбëюäåíèé -ðàñïðîñòðàíяюòñя íà îñíîâàíèå чåðåïà, ïðåèмóщåñòâåííî â îбëàñòü ïåðå-äíåé чåðåïíîé ямêè). Пî íàшèм äàííым, âыяâëåíы ó 50% бîëüíых [4]. 2. Âíóòðèчåðåïíыå îïóхîëè, ðàñ-òóщèå эêñòðàêðàíèàëüíî â ãëàзíèöó è îêîëîíîñîâыå ïàзóхè [3,27], ïî íàшèм äàííым, îбíàðóaeåíы ó 25% бîëüíых [5]. 3. Мåòàñòàòèчåñêîå ïîðàaeåíèå îñíîâàíèя чåðåïà è ëèöåâîãî ñêåëåòà.  мèðîâîé ëèòåðàòóðå мы íå íàшëè äàííых îб èх чàñòîòå ïðè ðàñïðîñòðàíåíèè íà îñíîâàíèå чåðåïà. Пî íàшèм äàííым, âыяâëåíы ó 15% бîëüíых [4]. 4. Çëîêàчåñòâåííыå îïóхîëè êîaeè, ïðîðàñòàющèå îêîëîíîñîâыå ïàзóхè, ãëàзíèöó è ïîëîñòü чåðåïà. Пî íàшèм äàííым, âыяâëåíы ó 10% бîëüíых [30].Мåòîäàмè ëåчåíèя êðàíèîфàöèàëüíых îïóхîëåé яâëяюòñя ïàëëèàòèâíыå è ðàäèêàëüíыå îïåðàöèè.  ïîëüзó âîзмîaeíîñòè âыïîëíåíèя ðàäèêàëüíых îïåðàöèé íà îñíîâàíèè чåðåïà è ëèöåâîм ñêåëåòå óмåñòíî ïðèâåñòè ðяä äîâîäîâ. Тâåðäàя îбîëîчêà ãîëîâíîãî мîзãà (ТÎÃМ) яâëяåòñя мîщíым бàðüåðîм, ñäåðaeèâàющèм èíâàзèю îïóхîëè â ïîëîñòü чåðåïà â òåчåíèå мíîãèх мåñяöåâ, чòî äàåò âîзмîaeíîñòü âыïîëíяòü ðàäèêàëüíыå âмåшàòåëüñòâà ñ ðåзåêöèåé ТÎÃМ [6,12]. Рîñò îïóхîëåé, ðàñïðîñòðàíяющèхñя â ïîëîñòü чåðåïà ïåðèíåâðàëüíî (чàщå àäåíîêèñ-òîзíыé ðàê) чåðåз îòâåðñòèя â îñíîâàíèè, ïî äî-ñòèaeåíèè ТÎÃМ òàêaeå зíàчèòåëüíî зàмåäëяåòñя, чòî ïîзâîëяåò âыïîëíяòü ðàäèêàëüíóю ðåзåêöèю чåðåïíых íåðâîâ äàaeå â ïðåäåëàх ïîëîñòè чåðåïà. Пðè èíòðàêðàíèàëü...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.