Surgifoam and mitoxantrone in the glioblastoma multiforme postresection cavity: the first step of locoregional chemotherapy through an ad hoc-placed catheter: technical note.
OBJECTIVE
To investigate the safety and feasibility of a novel form of treatment offered by the direct intraoperative application of a Surgifoam-mitoxantrone mix into a glioblastoma multiforme postresection cavity. A technique for the placement of an intracavity catheter connected with a subcutaneous reservoir for further locoregional mitoxantrone administration is also described.


METHODS
Between January and December 2004, 22 consecutive recurrent glioblastoma multiforme patients (14 men, 8 women; age, 56-72 yr; average, 64 yr; median, 65 yr) were enrolled in this study. All patients underwent image-assisted gross total resection of the pathological tissue. A Surgifoam-mitoxantrone mix (1 g Surgifoam powder, 3 ml physiological solution, and 12 mg mitoxantrone in 6 ml) was used to fill the surgical cavity. A ventricular catheter, connected to a Rickham subcutaneous reservoir, was then positioned in the surgical cavity for future mitoxantrone administration.


RESULTS
Toxic effects caused by mitoxantrone administration were not observed in any patients during the first postoperative month. On postoperative Days 1, 7, and 30, computed tomographic scans excluded surgical complications. In three patients, residual tumor was disclosed.


CONCLUSIONS
A mix of Surgifoam and mitoxantrone could be safely applied intraoperatively into the post-glioblastoma multiforme resection cavity without any observable side effects. This technique may benefit both the surgeon and the patient by taking advantage of the drug's hemostatic and cytostatic properties.
Ferroli
Paolo
P
Department of Neurosurgery, National Neurological Institute Carlo Besta, Milan, Italy. ferrolipaolo@hotmail.com
Broggi
Morgan
M
Franzini
Angelo
A
Maccagnano
Elio
E
Lamperti
Massimo
M
Boiardi
Amerigo
A
Broggi
Giovanni
G
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000493:pharmacokinetics; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000502:physiology; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D002408:Catheters, Indwelling / Q000592:standards / Q000639:trends; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005339:Fibrin Foam / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005909:Glioblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000592:standards / Q000639:trends; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage* / Q000493:pharmacokinetics; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011878:Radiotherapy; D013256:Steroids / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D005339:Fibrin Foam; D013256:Steroids; D008942:Mitoxantrone