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Neurological Surgery No Shinkei Geka Volume 21, Issue 6 （June 1993）

Neurological Surgery 脳神経外科 21巻6号（1993年6月発行）

Japanese English

研究

肺癌脳転移に対するACNU・CDDP動注化学療法—Mannitol動注併用の有無による比較 Intra-arterial ACNU, CDDP Chemotherapy for Brain Metastases from Lung Cancer—Comparison of cases with and without intra-arterial mannitol infusion 岩立康男 ¹ , 難波宏樹 ¹ , 三枝敬史 ¹ , 末吉貫爾 ¹ Yasuo IWADATE ¹ , Hiroki NAMBA ¹ , Takashi SAEGUSA ¹ , Kanji SUEYOSHI ¹ ¹千葉県がんセンター脳神経外科 ¹Department of Neurological Surgery, Chiba Cancer Center Hospital キーワード： Chemotherapy , Brain metastases , Lung cancer , Blood-brain barrier , Mannitol Keyword: Chemotherapy , Brain metastases , Lung cancer , Blood-brain barrier , Mannitol pp.513-518

発行日 1993年6月10日 Published Date 1993/6/10

DOI https://doi.org/10.11477/mf.1436900658

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Abstract 文献概要
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I．はじめに

　転移性脳腫瘍に対する治療は，手術と放射線療法が中心であり^{7,12,13,22）}，通常の化学療法の効果に関しては否定的な報告が多い^4,23,25）．脳以外の臓器に原発した癌に対する化学療法はすでに一定の評価を確立しており，脳腫瘍においては血液脳関門（blood-brain barrier：BBB）の存在を中心とした薬剤の組織移行の問題が大きな壁となっていると考えられる^{4-6,18,23,25）}．われわれは，転移性脳腫瘍に対しACNUとシスプラチン（CDDP）を用いた動注化学療法を施行してきたが，今回，肺癌脳転移症例に対しBBBを一時的に開く作用があるとされているマンニトール動注^{2,9,14-16,18,24,26）}を併用し，その臨床的効果を検討した．

To assess whether therapeutic efficacy is related to intra-arterial (IA) mannitol infusion prior to ACNU and cisplatin (CDDP) for brain metastases from lung can-cer, clinical results of patients with and without IA mannitol infusion were compared. Thirty-nine patients were randomly assigned to either a mannitol infusion group (group A) or a non-mannitol infusion group (group B). There were 22 patients in group A and 17 in group B. During radiotherapy, ACNU and CDDP, at a dose of 100mg/body, were given through the common carotid artery at a rate of 20 mg/min. In group A, 50 ml of 20% mannitol was injected intra-arterially at a rate of 50ml/min immediately prior to the injection ofchemotherapeutic agents.

Major complications, such as seizure and neurotoxic-ity, were not observed. Complete response (disappear-ance of enhanced tumor mass) was obtained in 72% of group A and in 67% of group B. The median time to tumor progression was 40 weeks for group A and 22 weeks for group B. The median survival time (MST) was 45 weeks for group A and 30 weeks for group B. The survival time was significantly longer in group A as compared to group B (p ＜ 0.05). When the patients who died of failure of vital organ systems other than brain complications were excluded in calculating the survival time, the MST was 69 weeks for 11 patients of group A and 34 weeks for 7 patients of group B. These data suggest that an effort to increase drug delivery to the brain tumor may indeed lengthen the survival time of patients with brain metastases from lung cancer.