Journal of Neuro-Oncology, Volume 72, Number 2, April, 2005, Pages 125-131, DOI:
10.1007/s11060-004-1497-5, Online Date May 31, 2005
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Intratumoral delivery of mitoxantrone in association with 90-Y
radioimmunotherapy (RIT) in recurrent glioblastoma Amerigo Boiardi1*,
Mirco Bartolomei4, Antonio Silvani1,
Marica Eoli1, Andrea Salmaggi1,
Elena Lamperti1,
Ida Milanesi3, Andrea Botturi1,
Paola Rocca4,
Lisa Bodei4, Giovanni Broggi2 and
Giovanni Paganelli4
(1) Department
of Neuro-oncology, Istituto Nazionale Neurologico, “C. Besta”, Via
Celoria 11, 20133 Milan, Italy. (2) Department of Neurosurgery,
Istituto Nazionale Neurologico, “C. Besta”, Milan, Italy. (3) Radiotherapy
Unit, Istituto Nazionale Neurologico, “C. Besta”, Milan, Italy.
(4) Nuclear Medicine Unit, Istituto Oncologico Europeo, Milan, Italy.
-- *Correspondence: Amerigo Boiardi, Email:
boiardi@istituto-besta.it, Phone: +39-022394343,
Fax: +39-0270638217.
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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.
Keywords: locoregional
chemotherapy, locoregional radioimmunotherapy, mitoxantrone, recurrent
glioblastoma
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