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Long-term outcome of patients with WHO Grade III and IV gliomas treated by fractionated intracavitary radioimmunotherapy.

Al's Comment:

 Although it is a small study, impressive results. Sounds similar  to a treatment that was done at Duke years ago which also showed good results but for unknown reasons development was stopped.


Posted on: 07/05/2015

J Neurosurg. 2015 Jul 3:1-11. [Epub ahead of print]
Long-term outcome of patients with WHO Grade III and IV gliomas treated by fractionated intracavitary radioimmunotherapy.
Reulen HJ1, Poepperl G2, Goetz C1, Gildehaus FJ2, Schmidt M3, Tatsch K2, Pietsch T4, Kraus T5, Rachinger W1.
 
Author information:
1Departments of 1 Neurosurgery.
2Nuclear Medicine;
3Munich Cancer Registry, Institute of Medical Informatics, Biometry, and Epidemiology, and.
4Department of Neuropathology, University of Bonn, Germany.
5Department of Neuropathology, Ludwig Maximilian University Munich, Klinikum Grosshadern, Munich; and.
 
Abstract
 
OBJECT The aim in this study was to present long-term results regarding overall survival (OS), adverse effects, and toxicity following fractionated intracavitary radioimmunotherapy (RIT) with iodine-131- or yttrium-90-labeled anti-tenascin monoclonal antibody (131I-mAB or 90Y-mAB) for the treatment of patients with malignant glioma. METHODS In 55 patients (15 patients with WHO Grade III anaplastic astrocytoma [AA] and 40 patients with WHO Grade IV glioblastoma multiforme [GBM]) following tumor resection and conventional radiotherapy, radioimmunoconjugate was introduced into the postoperative resection cavity. Patients received 5 cycles of 90Y-mAB (Group A, average dose 18 mCi/cycle), 5 cycles of 131I-mAB (Group B, average dose 30 mCi/cycle), or 3 cycles of 131I-mAB (Group C, 50, 40, and 30 mCi). RESULTS Median OS of patients with AA was 77.2 months (95% CI 30.8 to > 120). Five AA patients (33%) are currently alive, with a median observation time of 162.2 months. Median OS of all 40 patients with GBM was 18.9 months (95% CI 15.8-25.3), and median OS was 25.3 months (95% CI18-30) forthose patients treated with the 131I-mAB. Three GBM patients are currently alive. One-, 2-, and 3-year survival probabilities were 100%, 93.3%, and 66.7%, respectively, for AA patients and 82.5%, 42.5%, and 15.9%, respectively, for GBM patients. Restratification of GBM patients by recursive partitioning analysis (RPA) Classes III, IV, and V produced median OSs of 31.1, 18.9, and 14.5 months, respectively (p = 0.004), which was higher than expected. Multivariate analysis confirmed the role of RPA class, age, and treatment in predicting survival. No Grade 3 or 4 hematological, nephrologic, or hepatic toxic effects were observed; 4 patients developed Grade 3 neurological deficits. Radiological signs of radionecrosis were observed in 6 patients, who were all responding well to steroids. CONCLUSIONS Median OS of GBM and AA patients treated with 131I-mABs reached 25.3 and 77.2 months, respectively, thus markedly exceeding that of historical controls. Adverse events remained well controllable with the fractionated dosage regimen.
PMID: 26140493 [PubMed - as supplied by publisher]

 


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