OP38 * ROBOT-ASSISTED CONVECTION-ENHANCED DELIVERY OF CARBOPLATIN FOR PROGRESSIVE DIPG - A SAFETY AND FEASIBILITY REPORT OF 5 CASES

Abstract

INTRODUCTION: Convection-enhanced delivery is a method of drug delivery to the brain through implanted microcatheters. There has been significant research focus on applying CED to the treatment of DIPG, where prognosis remains poor. METHOD: 5 paediatric patients with tumour progression after radiotherapy were treated on compassionate grounds. Up to 4 catheter trajectories per patient were planned on pre-operative 3T MRI scans using custom-made planning software. Catheters were implanted using a robot-assisted technique. Infusions of carboplatin (0.18 mg/mL) were performed on 2 consecutive days. Serial T2W MRI was used to determine drug distribution. RESULTS: No adverse events related to implantation of catheters were observed. High volume (9mL/day), high flow rate infusions (10 µL/min) were performed. During infusions patients exhibited worsening of pre-existing neurological dysfunction, which was transient in all except one patient who required a prolonged period of non-invasive respiratory support. Real-time MRI indicated drug distribution throughout the majority of targeted tumour in 4 patients. Reduction in the volume of enhancing tumour was seen in 2 patients on follow-up imaging. CONCLUSION:Robot-assisted catheter insertion was safe and achieved satisfactory targeting. Satisfactory drug distribution was achieved in 4 out of 5 patients. Reduction in tumour enhancement was seen in 2 patients. Infusions were associated with only transient worsening of neurological function in all but one patient. This initial experience in 5 patients represents a strong foundation for a clinical trial of CED of carboplatin for DIPG.