Abstract
The authors present the results of intra-tumoral chemotherapy as a maintenance therapy for malignant glioma after remission induction therapy. The treatment was repetitive local administration of neocarzinostatin (NCS) into the tumor cavity through Ommaya's reservoir. Five of 6 treated cases survived over 1 year, and the other case expired 10 months after the therapy due to brain stem dissemination of the glioma, although the primary tumor was reduced in size on computed tomography (CT). Three out of 5 patients who survived over 1 year expired within 2 years, due to regrowth of the residual tumor in 2 cases and pneumonia in the third. One case has lived over 4 years. The good candidate for the intra-tumoral local chemotherapy was a patient with a singlecavity tumor and little residual tumor on CT. Histological examination using fluorescence micrograph showed that the fluorescein-labeled NCS had diffused into the tumor through the wall of the tumor cavity over 5 mm. Vacuolar degeneration and necrosis of the tumor cells and hyalinoid degeneration of the tumor vessels were the most characteristic findings. Side effects such as convulsion, hemiparesis or progression of cerebral edema on CT were not noted, but intra-tumoral hemorrhage was seen in one patient, who received about 100 μg NCS in one shot. Cytological examination of the liquid content of the tumor cavity during the treatment showed abundant macrophages with destroyed tumor cells. NCS was found to be the more effective drug not only as an anti-cancer agent, but also as an immunotherapeutic agent.
