Fluorescence-sodium Guided And Implant Carmustine In The Treatment Of Glioma: A Clinical Study

Gliomas have the highest incidence of primary malignant brain tumor,and data statistics showing 1-year and 2-year survival rate are only 53.7%and 14.6% of patients with high-grade gliomas. the patients have a great chance with poor prognosis. Because of it’s difficulty of treatment, high morbidity, high rate of recurrence, high rate of death and low cure rate,most patients have very poor prognosis. Neurosurgeons are still facing many problems of glioma’s treatment.The treatment of glioma is multimodality therapy which included surgery, radiotherapy and chemotherapy. The first project in glioma’s treatment is surgery as shown in the clinical studies, and it is also considered as the most important factor of prognostic and survival. Compared to the 50% resection, we will get a significant different prognostic when 70% of tumor are resected. As a result, the patients will prolong the postoperative survival time. However,it is so hard to distinguish the tumor boundary and normal tissue of brain,so that it is more difficult to resect the tumor completely. The key in this surgery is confirm the tumor and resect it. Sodium fluorescein can make the tumor and the tissue around it become yellow-green light, and this light can guide the doctor to rescet the tumor. At the same time,chemotherapy is also one of important steps to cure the glioma and prevent recurrence. Because of most of glioma relapse in 2cm area of surgery,carnustine can eliminate remnant tumor to control or delay it’s recurrence through high concentration and long time effection of drug. Carnustine can avoid the blood brain barrier and put the drug on the cell of tumor directly.Beside, this method can also reduce side-effect of other systems. The implant biological materials carry the drug to the tumor cavity, and drug can release to the tissue around the cavity with degradation of the materials. The drug concentration of the carnustine release in the brain was120 times higher than that of the conventional intravenous injection. After implanting, the diffusion distance can reach 4cm, besides, local stability and high concentration are the key to kill tumor cells in the brain. In this study, we combine the sodium fluorescein and carnustine to discuss the clinical effection of this method.Objective:To evaluate the clinical value of sodium fluorescein and implant carnustine in the treatment of glioma.Methods:There are 60 patients diagnosed with glioma which are enrolled in December 2013 to December 2015 were randomly divided in four groups.The tumor of fifteen cases are removed in the operation with fluorescein sodium. The tumor of fifteen cases are removed by the ordinary way ofsurgery. The tumor of fifteen cases are removed in the operation with fluorescein sodium, and use the temozolomide in chemotherapy after the operation. The tumor of fifteen cases are removed in the operation with fluorescein sodium, and implant the carnustine in chemotherapy during the operation. The surgeon resect the tumor according the degree of the sodium fluorescein(dark yellow, light yellow, no staining). We collect the data of all patients and through χ2 test, we analysis these data, especially total cut rates, progression-free-survival, KPS score.Results:1. All the groups of sodium fluorescein have the more better tot al cut rate than the ordinary group by MRI on the 3rd day after op-eration. Furthermore, the resected tunors are consist with the pathol ogical examination.2. Twelve cases, thirdteen cases, twelve cases of patient were totally cut in the sodium fluorescein group(80%, 73.3%, 80.0%). Eight cases’ tumor are totally removed in ordinary group. The difference of the data was significant(P<0.05).3. Difference of KPS score is significant between pre-operation and post-operation in the sodium fluorescein group when the tumor refer to the area of function(P<0.05). The ordinary group is not(P>0.05).4. The survival curve of the fourth group is better than other groups.Conclusion:1. The technique of sodium fluorescein can increase the total cut rate,and when the tumor refer to the functional area, it can increase the KPSscore.2. The survival curve of implanting the carnustine is better than the group of using temozolomide.3. The fourth group can prolong the progression-free-survival compared to traditional resection operation and chemotherapy.