Clinical Observation Of Bleomycin Combined With Teniposide (VM-26) Intratumoral Chemotherapy For Treating Glioma

Objective Preliminary explore the safety and efficacy of bleomycin combined withteniposide(VM-26)intratumoral chemotherapy for treating glioma through an Ommayareservoir after the resction of glioma.Methods9patients were enrolled in our group,who have operated on theneurosurgery department of the first affiliated hospital of Soochow University fromSeptember2,2010to September21,2012,with complete medical records and follow-updata and confirmed by postoperative pathological examination for glioma.6cases wereWHO grade II astrocytomas,1case was WHO grade II oligodendrogliomas,1case wasWHO grade III anaplasic astrocytomas,1case was WHO grade IVglioblastomas(GBM).All9cases placed an Ommaya reservoir in the tumor residual cavityafter maximum safe resection,1-4weeks started intratumoral chemotherapy aftersurgery.Dosage schedule were4consecutive days to deliver bleomycin(1ml:7.5mg，d1,d2)and VM-26(1ml:10mg,d3,d4), respectively.Repeat interval21days as a cycle ofintratumoral chemotherapy.The complication was observed after intratumorachemotherapy.We followed up its curative effect by head CT or MRI etc and evaluated itsadverse reactions by acute and subacute toxicity of anticancer drugs classification standardof the U.S. national cancer institute.Results8cases received six cycles of intratumoral chemotherapy followed byradiotherapy.1case(GBM) received1cycle of intratumoral chemotherapy followed byradiotherapy,who continued to receive2cycle of intratumoral chemotherapy after the endof radiotherapy.The deadline of follow-up is March21,2013.The patients were followed up6-30months.The median follow-up time were18months.No deaths.7cases with stabledisease, after six cycles of intratumoral chemotherapy,thin line appearance and high signalintensity areas could be seen in the marginal zone of the tumor cavity on thegadolinium-enhanced T1-weighted MRI,the boundary is clear,but there was no masseffect.Further follow-up with CT or MRI showed no sign of recurrence and progress andhad a normal life.2cases with progressive disease,Of1case new lesions was observed onMRI(about6months after the operation),of1case local recurrence was observed onMRI(about3months after the operation).Except1case appeared local skin redness andshrinkage above the Ommaya reservoir(grade II-III toxicity reaction, considering for drugleakage),all9cases neither had epilepsy, intracranial infection, intracranial hematoma,blocking pipe, or other serious complications which related to the local drug deliverthrough an Ommaya reservoir,nor had systemic or local adverse reactions such asmyelosuppression,liver and kidney function damage, nerve toxicity,and so on.Conclusion Bleomycin combined with VM-26intratumoral chemotherapy fortreating glioma through an Ommaya reservoir is a relatively safe treatment.Its short-termcurative effect is better.Because this group of samples is less, follow-up time is shorter, itslong-term effect remains to be further followed up and confirmed in large randomizedcontrolled researches.