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Stereotaxic
implantation of 5-fluorouracil-releasing microspheres in malignant glioma
Menei P, Jadaud E,
Faisant N, Boisdron-Celle M, Michalak S, Fournier D, Delhaye M, Benoit JP
Department
of Neurosurgery, Centre Hospitalo-Universitaire d'Angers, 49033 Angers Cedex 01,
France. phmenei@chu-angers.fr
Background. The authors developed a new method of drug delivery
into the brain using implantable, biodegradable microspheres.
The strategy was evaluated initially to provide localized and sustained delivery
of the radiosensitizer 5-fluorouracil (5-FU) after patients underwent surgical
resection of malignant glioma.
In this study, the microspheres were implanted by stereotaxy into deeply
situated and inoperable brain tumors.
Methods.
Ten patients with newly diagnosed, inoperable, malignant gliomas were included
in the study, and 1 dose of 5-FU was studied (132 mg).
After histologic confirmation, a suspension of poly(D-L lactide-co-glycolide)
5-FU-loaded microspheres was implanted by stereotaxy into the tumor in one or
several trajectories with one to seven deposits per trajectory.
External beam radiation (59.4 grays) was started before postoperative Day
7.
Patients were followed by clinical examination, computed tomography scanning,
magnetic resonance imaging, and 5-FU assays in blood and cerebrospinal fluid
(CSF).
Results.
The number of trajectories was adapted to the size and shape of the tumor.
Microsphere implantation was tolerated well, except in four patients who
received a single trajectory and experienced a transitory worsening of
preexisting neurologic symptoms.
There were no episodes of edema or hematologic complications.
5-FU was detected in CSF and blood in some patients at very low
concentrations.
The median overall survival was 40 weeks, with 2 patients who had longer
survival (71 weeks and 89 weeks, respectively).
Conclusions.
In this study, the authors demonstrated that biodegradable microspheres could be
implanted by stereotaxy and were efficient systems for drug delivery into brain
tumors.
This method may have future applications in the treatment of patients other
malignancies.
Copyright 2003 American Cancer Society.
PMID: 14716778 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14716778&dopt=Abstract |
