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Intratumoral delivery of mitoxantrone in association with 90-Y radioimmunotherapy (RIT) in recurrent glioblastoma

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Summary

Twenty-six recurrent Glioblastoma (rGBM) patients sequentially treated at the National Neurological Institute ‘C Besta’ were enrolled for a second surgery in order to remove recurrent tumor and to place an Ommaya reservoire to allow local delivery of chemotherapy and local pre-targeted radio-immunotherapy (RIT). All patients had partial tumor resection and 75% of them had a residual tumor mass after exeresis larger than 2 cm. After surgery all patients were managed with a second line systemic chemotherapy (PCV). Moreover the protocol scheduled two cycles of local RIT (90 Yttrium 5– 25 mCi per cycle) with a 10 week interval. Locoregional mitoxantrone chemotherapy was locally delivered as a single dose of 4 mg every 20 days. Responses to treatment were assessed by monthly neurological examination and by MRI or contrast-enhanced CT scan performed every 2 months.

For the whole group of patients the PFS after second surgery at 6 and 12 months was 61% and 22%, respectively and survival after recurrence at 6, 12 and 18 months was 80%, 53% and 42%, respectively. Neither major side effects occurred systemically nor related on the place of local injections. The percentage of long-term survivors was very high: 42% of patients were still alive at 18 months. We stress the concept that the combined treatments could be more effective if delivered into a smaller residual tumor mass and probably in an adjuvant setting, before tumour recurrence.

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Authors and Affiliations

  1. Department of Neuro-oncology, Istituto Nazionale Neurologico, “C. Besta”, Via Celoria 11, 20133, Milan, Italy

    Amerigo Boiardi, Antonio Silvani, Marica Eoli, Andrea Salmaggi, Elena Lamperti & Andrea Botturi

  2. Department of Neurosurgery, Istituto Nazionale Neurologico, “C. Besta”, Milan, Italy

    Giovanni Broggi

  3. Radiotherapy Unit, Istituto Nazionale Neurologico, “C. Besta”, Milan, Italy

    Ida Milanesi

  4. Nuclear Medicine Unit, Istituto Oncologico Europeo, Milan, Italy

    Mirco Bartolomei, Paola Rocca, Lisa Bodei & Giovanni Paganelli

Authors
  1. Amerigo Boiardi
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  2. Mirco Bartolomei
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  3. Antonio Silvani
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  4. Marica Eoli
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  5. Andrea Salmaggi
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  12. Giovanni Paganelli
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Correspondence to Amerigo Boiardi.

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Boiardi, A., Bartolomei, M., Silvani, A. et al. Intratumoral delivery of mitoxantrone in association with 90-Y radioimmunotherapy (RIT) in recurrent glioblastoma. J Neurooncol 72, 125–131 (2005). https://doi.org/10.1007/s11060-004-1497-5

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