SCDT-21. CEREBRAL INTRAARTERIAL CHEMOTHERAPY IN THE TREATMENT OF MALIGNANT GLIOMAS: READY TO RISE AGAIN

• Published in: Neuro-oncology (Charlottesville, Va.) Vol. 19; no. suppl_6; p. vi269
• Main Authors: Fortin, David, Gahide, Gerald, D’aout, Celine, St-Pierre, Isabelle, Roy, Marie-André, Iorio-Morin, Christian
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 06.11.2017
• Subjects: Abstracts
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nox168.1104

Contemporary treatment of glioblastoma involves an optimal surgery, followed by a combination of radiation and temozolomide. The reported progression-free survival with this treatment is only 6.9 months. At recurrence, few therapeutic options are available given the paucity of chemotherapeutics crossing the blood-brain barrier (BBB). Cerebral Intra-arterial Chemotherapy (CIAC) in the treatment of gliomas allows to bypass the BBB and the brain-tumor barrier (BTB), but fell into oblivion after a major randomized study led by the BTCG showed no therapeutic advantages, and a major complication profile. Looking at the reasons for this failure, the choice of chemotherapeutics, concentration, volume and infusion rate, catheter placement can all be invoked. But nowadays, with refinements in angiographic hardware and technics, and the availability of new therapeutics, CIAC is ready to rise again. In this work, we present the largest series of glial tumors treated by CIAC to our knowledge. Over 15 years, 463 glial tumors comprising 319 GBM tumors were treated at the CHUS (centre Hospitalier Universitaire de Sherbrooke) with a standardized CIAC protocol of monthly carboplatin administration. All patients were treated at relapse. Seventeen percent were treated at first relapse, 68% at second relapse, 11% at third relapse and 4% at fourth. Overall, the patient received a median of 4 cycles (1 to 22 cycles). The whole series presented an overall median survival of 25 months, whereas survival from study entry was 8 months for the entire cohort. Ten patients are still alive, with the longest survival now at 12 years. The overall complication rate was 0.75%, with the most frequent occurrence being lacunar strokes. We believe that a better selection of patient, molecular subclassification, and the continued search for chemotherapeutics will improve these results. The procedure is safe, and should be considered an easy and viable delivery option to circumvent BBB.