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Surgifoam and Mitoxantrone in the
Glioblastoma Multiforme Postresection Cavity: The First Step of
Locoregional Chemotherapy through an Ad Hoc-placed Catheter: Technical
Note
Paolo Ferroli, M.D.; Morgan Broggi,
M.D.; Angelo Franzini, M.D.; Elio Maccagnano, M.D.; Massimo Lamperti,
M.D.; Amerigo Boiardi, M.D.; Giovanni Broggi, M.D.
Department of Neurosurgery, National
Neurological Institute Carlo Besta, Milan, Italy. ferrolipaolo@hotmail.com
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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.
Conclusion. 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.
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