Читать книгу Intracranial Gliomas Part III - Innovative Treatment Modalities - Группа авторов - Страница 22

In 13 patients of our series PDT with Photofrin^® was applied for residual glioma after its maximal resection guided by intraoperative 5-ALA-induced tissue fluorescence. In these cases infiltration of functionally important brain structures (8 cases) or spinal cord (5 cases) precluded complete tumor removal. There were 8 men and 5 women aged from 30 to 63 years. Cerebral gliomas comprised 3 GBM, 4 AA, and 1 anaplastic ependymoma, whereas spinal cord tumors included 3 AA, 1 anaplastic ependymoma, and 1 diffuse astrocytoma. With one exception, all neoplasms were recurrent after one or several relapses.

Fig. 1. Treatment for a second relapse of glioblastoma in a 59-year-old woman after tumor resection, chemoradiotherapy, and re-resection. Post-contrast T1-weighted images demonstrate separate focuses of recurrent neoplasm within the left frontal lobe and corpus callosum (a–c), which underwent stereotactic interstitial photodynamic therapy through 8 targets located 10 mm apart within each lesion (d) with the use of a BRW stereotactic frame (e), optical fiber and semiconductor laser beam (f). The total amount of delivered photo-irradiation energy was 1440 J. Postoperative course was uneventful and in 4 weeks complete response of both tumors to treatment was observed (g–i). The patient remained alive during >4 years after treatment.

5-ALA at a dose of 20 mg/kg and Photofrin^® at a dose of 2 mg/kg were administered prior to surgery. Cerebral gliomas were usually operated on during awake craniotomy with intraoperative brain mapping and comprehensive neurophysiological monitoring [10, 11]. After maximal tumor resection the surface of the residual neoplasm left within functionally important structures underwent photo-irradiation using a 630 nm wavelength laser beam with an energy density of 180 J/cm². The technique of PDT in cases of spinal cord tumors was essentially the same as with cerebral ones.

In overall, postoperative neurological deterioration was noted in 2 patients, neurological status remained unchanged in 8, and improvement of symptoms was marked in three. Among 8 patients with cerebral gliomas postoperative neurological deterioration was noted in one, neurological status remained unchanged in 5, and improvement of symptoms was marked in two. Five patients died within 2–4 years after surgery, whereas 3 (two with AA and one with GBM) remained alive for more than 5 years, maintaining a KPS score of 70–80, and have no evidence of tumor relapse on post-contrast MRI.