Romanian Neurosurgery (Jun 2023)
Prospective study of selective intra-arterial cerebral infusion and intra-operative local application of carboplatin for recurrent glioblastoma multiformis
Abstract
Background. High-grade glioma is the commonest primary malignant brain tumour in adults. Intra-arterially selectively infused chemotherapeutic agents into the tumour bulk is being widely trialled recently with promising results. Methods. This is a prospective study designed between November 2015 and November 2019. Thirty patients were diagnosed with recurrent histo-pathologically proven GBM after one surgery at least and followed by standard radiotherapy and temodal. Patients aged between 37-76 years, 18 males and 12 females were subdivided into group A of 21 patients who underwent intra-arterial delivery of carboplatinand group B of 9 patients who underwent re-surgical resection and local application of carboplatin. Results. The mean age of the included cases was 55.4 years (range, 37-76 years). Selective intra-arterial injection was performed in 21 cases (70%), while the remaining 9 cases (30%) had local application of carboplatin in the tumour bed. Post-treatment vomiting was reported in 7 cases (23.3%). Significant and partial responses were achieved in 2 cases for each (6.7%). Time to tumour progression had a mean of 19.03 weeks (range, 3 – 30 weeks). After receiving carboplatin, the study cases had a mean survival of 26.5 weeks (range, 6 – 70 weeks). Intra-arterial injection had significantly better results compared to local tumour bed infiltration (p = 0.01). Conclusion. Although recurrent glioblastoma multiformis has poor survival, intra-arterial delivery of carboplatin may have a slight positive impact on patient survival. The procedure however is relatively safe with manageable complications.
