Intraarterial Cis-Platinum Chemotherapy for Patients with Primary and Metastatic Brain Tumors

Abstract

A total of 49 patients were treated using intraarterial cis-platinum infusions at a dose of 100 mg/m2. The patients were separated into three groups. There were 13 patients with metastatic tumors, 10 with recurrent malignant gliomas, and 22 patients with high-grade gliomas who received intraarterial cis-platinum as part of an adjuvant program. In addition, four nongliomatous primary brain tumors were treated in this fashion. Cis-platinum was filtered immediately prior to intraarterial infusion using a 0.22-micron filter. Response to treatment was evaluated by follow-up CAT scans and neurologic examinations. There were three complete and eight partial responses in metastatic tumors, and eight partial responses in recurrent gliomas. The median survival was 19 weeks for patients with metastatic disease, and 16 weeks for patients with recurrent gliomas. Those high-grade glioma patients who received intraarterial cis-platinum as adjuvant chemotherapy along with CCNU and radiation therapy had a projected median survival of 91+ weeks. Toxicity from intraarterial cis-platinum following drug filtration was markedly reduced when compared with previous reports. Only five patients experiencing visual or central nervous system toxicity utilizing filtered cis-platinum and no radiographic or histopathologic evidence of central nervous system toxicity was observed. Bilateral deafness was observed following vertebral artery infusion in both patients treated in this manner and thus vertebral artery infusions should be avoided. Systemic toxicity was mild. Intracarotid infusion is a safe, well-tolerated delivery system for filtered cis-platinum with a high response rate for patients with both metastatic and primary malignant brain tumors.

Vascular Distribution of Glioblastoma Multiforme at Diagnosis

“…Selective IA administration of chemotherapeutics carries its own set of risks. Infra-ophthalmic carotid administration has been associated with CNS and retinal toxicity 14,15 , leukoencephalopathy 16 and deafness 17 . Headache, seizures, transient mental status changes, groin hematomas and urinary retention or incontinence have been reported 18 .…”

Cis-diamminedichloroplatinum (CDDP) therapy for brain metastasis of lung cancer

“…Kolaric et al [8] observed a complete response to intravenous CDDP treatment in one of eight patients, partial response in two, disease stabilization in one, and progression in four, that is, an overall a positive response rate of 3/8. Lehane and colleagues [17] reported a complete response to intra-arterial CDDP administration in one of eight patients, partial response in five, and no response in two, that is, an overall response rate of 6/8. Feun et al [18] reported a positive response in one of three patients given intra-arterial CDDR disease stabilization in one, and no response in one.…”

“…In general, the response of lung cancer to CDDP therapy seems to vary from case to case, depending on the sensitivity of the individual's cancer cells to this drug. Regarding chemotherapy of metastatic brain tumor derived from lung cancer, treatment with CDDP alone has been found to be efficacious in three separate studies [8,17,18]. Kolaric et al [8] observed a complete response to intravenous CDDP treatment in one of eight patients, partial response in two, disease stabilization in one, and progression in four, that is, an overall a positive response rate of 3/8.…”

“…Feun et al [18] reported a positive response in one of three patients given intra-arterial CDDR disease stabilization in one, and no response in one. Many authors have noted that CDDP is more effective when administered intra-arterially than when given by intravenous infusion [17][18][19][20][21]. This drug readily binds with plasma proteins, therefore free CDDR which is believed to be active, may be more effectively delivered to the tumor by intra-arterial than by intravenous infusion, resulting in greater antitumor effects.…”

Neoadjuvant Intracarotid Chemotherapy for Treatment of Advanced Adenocystic Carcinoma of the Lacrimal Gland

“…These tumors have demonstrated salutary response to cisplatin and doxorubicin therapy. 3 Intra-arterial delivery of chemotherapy is an accepted treatment for extremity osteosarcoma, [4][5][6] central nervous system tumors, [7][8][9][10] primary and metastatic liver [11][12][13] tumors, and breast cancer in selected patients. [14][15][16] The major advantage of intra-arterial drug infusion is the ability to administer a dose of therapeutic agent to the area of involvement through an undisturbed vascular system, resulting in a better therapeutic index ( Table 1).…”