Intratumoral delivery of mitoxantrone in association with 90-Y radioimmunotherapy (RIT) in recurrent glioblastoma.
Twenty-six recurrent Glioblastoma (rGBM) patients sequentially treated at the National Neurological Institute 'C Besta' were enrolled for a second surgery in order to remove recurrent tumor and to place an Ommaya reservoire to allow local delivery of chemotherapy and local pre-targeted radio-immunotherapy (RIT). All patients had partial tumor resection and 75% of them had a residual tumor mass after exeresis larger than 2 cm. After surgery all patients were managed with a second line systemic chemotherapy (PCV). Moreover the protocol scheduled two cycles of local RIT (90 Yttrium 5- 25 mCi per cycle) with a 10 week interval. Locoregional mitoxantrone chemotherapy was locally delivered as a single dose of 4 mg every 20 days. Responses to treatment were assessed by monthly neurological examination and by MRI or contrast-enhanced CT scan performed every 2 months. For the whole group of patients the PFS after second surgery at 6 and 12 months was 61% and 22%, respectively and survival after recurrence at 6, 12 and 18 months was 80%, 53% and 42%, respectively. Neither major side effects occurred systemically nor related on the place of local injections. The percentage of long-term survivors was very high: 42% of patients were still alive at 18 months. We stress the concept that the combined treatments could be more effective if delivered into a smaller residual tumor mass and probably in an adjuvant setting, before tumour recurrence.
Boiardi
Amerigo
A
Department of Neuro-oncology, Istituto Nazionale Neurologico, C. Besta, Via Celoria 11, 20133, Milan, Italy. boiardi@istituto-besta.it
Bartolomei
Mirco
M
Silvani
Antonio
A
Eoli
Marica
M
Salmaggi
Andrea
A
Lamperti
Elena
E
Milanesi
Ida
I
Botturi
Andrea
A
Rocca
Paola
P
Bodei
Lisa
L
Broggi
Giovanni
G
Paganelli
Giovanni
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001855:Bone Marrow Diseases / Q000139:chemically induced; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016503:Drug Delivery Systems / Q000379:methods; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D036502:Infusions, Intralesional; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D010865:Pilot Projects; D016499:Radioimmunotherapy / Q000379:methods*; D015021:Yttrium Radioisotopes / Q000008:administration & dosage*
D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes; D008942:Mitoxantrone