Primary Cerebral Lymphomas and Regional Transarterial Chemotherapy with a Blood-Brain Barrier Break

Aronov ., Yakovlev S., Kobyakov G., Bocharov ., Lubnin ., Israelyan L.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

A blood-brain barrier (BBB) conditions limited penetration of water-soluble preparations into cerebral tumors. Intra-arterial chemotherapy (IACH), carried out under conditions of a temporary osmotic break of BBB, permits to achieve a two-fivefold increase of a drug concentration within tumor stroma in comparison with concentrations in its I/V administration; as for perifocal cerebral tissue, this index is 10-100 times greater.

Material and Methods. IACH with a BBB break was used in 16 cases with primary cerebral lymphoma. Their age varied from 26 up to 68 years. There were 7 females and 9 males. Single and multiple lesions were watched in 12 and 4 patients respectively. A total number of procedures was 25. They were carried out once, twice and thrice in 8, 7 and 1 cases respectively.

Results. One could observe some unusual physiologic responses during an osmotic break of BBB and subsequent IACH. According to CT and MRI, a partial or complete response to treatment took place in 91.3% of cases. There were no fatal outcomes, caused by procedures. Unfavorable prognostic factors included an initial severe condition and former courses of systemic polychemotherapy. Two cases died during a month after the procedure due to progression of the disease and initial severity of their state. A complete response (no tumor filling in CT or MRI examinations) was obtained in 5 cases (31.5%), who had single lesions and the score of 70 according to Karnofsky scale.

Conclusion. IACH with a break of BBB can be used as a method of choice in primary cerebral lymphomas. It is planned to continue studies and to analyze clinical data in detail.