恶性脑肿瘤化疗方案.ppt

A/E: 颈动脉灌注高渗溶液, 迅速改变BBB 通透性 20%甘露醇150-250ml, 5-10ml/sec BBB血管内皮细胞收缩 胞间紧密联接增宽 ↓ 脑组织含水量增加1.0%-1.5% ↓ 4hr恢复正常 20世纪80年代用于临床 尚未Ⅲ期研究证实 近年研究: BBB开放无选择性, 内皮细胞破坏: 正常脑组织肿瘤,正常脑组织暴露化疗药物↑ 高渗性BBB开放 Blood brain barrier disruption (BBBD) and intra-arterial methotrexate based therapy for newly diagnosed primary CNS lymphoma: The BBBD Consortium Experience. 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S 4 institutions： 1982-2005， 177 PCNSL BBBD/IA MTX ；2,469 procedures Pts CR PR ORR M OS(y) MPFS(y) PFS-5(y) 177 101 41 80.2% 3.1 1.6 40% A Phase II Trial Involving Patients with Recurrent PCNSL Treated with Carboplatin/BBBD, by Adding Rituxan (Rituximab), an anti CD-20 Antibody, to the Treatment Regimen Phase I/II Study of Carboplatin, Melphalan and Etoposide Phosphate in Conjunction with Osmotic Opening of the Blood-Brain Barrier and Delayed Intravenous Sodium Thiosulfate Chemoprotection, in Subjects with Anaplastic Oligodendroglioma or Oligoastrocytoma Phase II Clinical Trial of Patients with High-Grade Glioma Treated with Intra-arterial Carboplatin-based Chemotherapy, Randomized to Treatment with or without Delayed Intravenous Sodium Thiosulfate as a Potential Chemoprotectant against Severe Thrombocytopenia Intra-arterial Melphalan (L-phenylalanine mustard) Administered in Conjunction with Osmotic Blood-Brain Barrier Disruption in Patients with Brain Malignancies: A Phase I Study Neuro-Oncology Blood-Brain Barrier Program Oregon Health Science UniversityBlood Brain Barrier and Neuro-Oncology Program 替尼泊苷联合尼莫司汀治疗转移性脑肿瘤 治疗方法： VM26　100mg,iv,gtt,D1-3,4周重复 ACNU　2-3mg/kg,iv,gtt,D1,4-6周重复 化疗前20%甘露醇250ml,iv,gtt,DXM10mg,iv ACNU共计47周期，平均2.3 VM26共计49周期，平均2.5 中国癌症杂志Vol9, No2, June,1999 替尼泊苷联合尼莫司汀治疗转移性脑肿瘤 研究对象 男性： 　　 11例 女性： 　　 9例 年龄： 　　 33-70岁 原发肿瘤病理类型： 肺癌 　　 12例 乳腺癌 　　 1例 恶性淋巴瘤 　　 3例 鼻咽癌 　　 1例 滑膜肉瘤 　　 1例 不明肿瘤 　　 2例 中国癌症杂志Vol