Clinical research of the treatment of malignant gliomas by local administration of adriamycin. A statistical study of 118 cases

Abstract

The purpose of this study is to present the results of a clinical trial of local administration for malignant gliomas based upon anti-cancer agents, mainly on adriamycin.Ommaya devices, tube and reservoir were prepared, which had been chosen and improved. The following techniques were employed for implantation and local chemo-therapy. (1) Implantation into the remaining tumor cavity at the time of excision. (2) After an interval of one week, when the skin incision adhered, local administration was begun by injecting the agents into reservoir with 27 gauge needle, followed by the injection of 1-2 ml saline for diffusing the agent. Of 136 glioma cases having been experienced for 10 years, 118 cases had been operated, and 79 out of operated cases were implanted at the time of excision. Thereafter, both radiation and whole body chemo-therapy with adriamycin, ACNU, VCR and 5-FU were performed in most patients.Of 79 cases, 63 cases were locally administered with adriamycin, 5 cases with ADM + BLM, 7 cases with BLM, 4 cases with MTX. According to the pathological classifications, statistics in ADM cases were analized in comparison with the other agents group and 39 cases in which no agent was locally administered.Survival rates and curves were estimated and drawn by the Kaplan-Meier method and z-test. The ADM group consisted of 63 cases, 6 cases of astrocytoma grade 2, 14 cases of astrocytoma grade 3, 40 cases of astrocytoma grade 4, 1 of epemdymoblastoma and 2 cases of medulloblastoma. In ADM group, survival rate at the time of 36 months was 80% in astrocytoma grade 2, 58% in astrocytoma grade 3, 36% in astrocytoma grade 4. In any of pathological classes, cases with over 75% tumor removal showed longer prognosis than those with under 75% tumor removal. The tendency was conspicuously observed in astrocytoma grade 4.This method has the following advantages: (1) It is possible to change amounts and interval of local administration for both old or infant cases. (2) It seldom has side-effect on other organs. (3) It is possible to employ local injection of antibiotics on the occasion of local infection, and the removal of the apparatus is easy in contrast with the other procedures of local chemo-therapy.