抄録
Adjuvant immunochemotherapy and irradiation therapy were applied following surgery for gliomas from 1975 to 1978. It is the authors' principle to remove the tumor extensively. About one week after the operation, irradiation was started. Along with the irradiation, adjuvant immunochemotherapy was also started. For supratentorial gliomas, initially, adriamycin was given in three divided dosis of 0.5 mg/kg, up to 30 mg, on every other day. After a rest of 6 weeks, methyl-CCNU was given in a single dose of 3 mg/kg orally. This course of treatment was repeated after another 6 weeks. Along with the chemotherapy, OK-432 was given as an immunopotentiator. For medulloblastomas, methyl-CCNU was given at first, in a single dose of 3 mg/kg. After a rest of 6 weeks, methotrexate was given intrathecally via an Ommaya reservoir on five successive days in a single dose of 0.25 mg/kg. After another 6 weeks methyl-CCNU was repeated every 6 weeks. Methotrexate was also given during the spring, summer and winter vacations. OK-432 was also administered. This combined therapy was applied to 14 cases of supratentorial malignant gliomas, seven cases of supratentorial low grade gliomas, and 10 cases of medulloblastomas. In addition, nine low grade gliomas in the brain stem without surgery received this therapy.
The survival rate ofsupratentorial malignant gliomas was 79% for one year, 50% for two years and 46% for three years. The survival rate of medulloblastomas was 80% for one year, 67% for two years, and 57% for three years. All the survivors among medulloblastoma cases could go to school or kindergarden.
Toxicity was examined by white blood cell count, liver function, renal function and lymphocyte count. The difference of mean white blood cell counts between the first postoperative year and thereafter was not significant. GOT and GPT were elevated in the early postoperative period, but returned to normal values in the late postoperative period. ALP increased in the late postoperative period. Throughout the course of immunotherapy, it is necessary to measure immunoparameters. Lymphocyte count and PPD skin test were measured. Difference of lymphocyte counts between the first postoperative year and thereafter was not significant. Although the lymphocyte count was said to be depressed in glioma cases, and especially during chemotherapy, this series showed no apparent immunosuppression. Because some toxicity, such as elevating ALP, was noted, it seems better to discontinue the combined therapy at the end of the second postoperative year.
