Oligodendroglial Tumors: Intra-arterial Chemotherapy

Abstract

Brain tumors with an oligodendroglial component represent up to 20% of all primary brain tumors. Many of these tumors are sensitive to procarbazine, lomustine and vincristine (PCV), or temozolomide (TMZ) chemotherapy. In patients with oligodendroglial tumors that are resistant to PCV or TMZ chemotherapy, few treatment options are available and improved therapy is needed. One strategy, administration of chemotherapy via the intra-arterial (IA) route, can result in a higher concentration of drug delivery to the brain and brain tumor cells, with a lower systemic exposure, resulting in increased tumor-specific cytotoxicity, and avoidance of systemic toxicities. Osmotic blood-brain barrier disruption (BBBD), achieved by IA infusion of a hyperosmotic agent such as mannitol, can further intensify drug delivery to the tumor and surrounding brain, particularly in smaller, less permeable tumors and when using higher-molecular weight chemotherapy agents. General experience with IA chemotherapy, and IA chemotherapy combined with BBBD in patients with many tumor types is extensive. In the case of aggressive oligodendroglial tumors, hopeful results have been reported using combination delivery of IA chemotherapy (IA melphalan, IA carboplatin and IV etoposide phosphate) in conjunction with BBBD, with acceptably low toxicity and encouraging response data in many patients. Delivery of chemotherapy via the IA route, in conjunction with BBBD may be a good option in those with aggressive oligodendroglial tumors. Further work is required to uncover the true potential of IA therapy in the setting of aggressive oligodendroglial tumors.KeywordsPrimary Central Nervous System LymphomaOligodendroglial TumorAnaplastic OligodendrogliomaPrimary Central Nervous System Lymphoma PatientEtoposide PhosphateThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.