Clinical significance of prophylactic intrathecal chemotherapy in the treatment of glioblastoma multiforme

e13022

Backgrounds: We previously have reported that hypo-fractionated high-dose irradiation (HdI; 68Gy/8F) showed excellent local control but no effect on prevention of cerebrospinal fluid dissemination (CSFd), resulted in limited efficacy on patients’ survival in glioblastoma (GBM). The aim of present analysis is to evaluate the clinical significance of prophylactic intrathecal administration of thiotepa (iT) in the treatment of GBM patients. Methods: Histologically confirmed GBMs without CSFd at diagnosis were enrolled. Patients were classified into four groups owing to the post-surgical treatment strategy as follows: Group A patients (n = 65) were treated by conventional radiotherapy (cRT; 60Gy/30F) alone; Group B patients (n = 17) were by cRT concurrent witn iT; Group C patients (n = 28) were by HdI alone; Group D patients (n = 30) were by HdI concurrent with iT. In Group B and D, Ommaya reservoir was placed into the lateral ventricle and 10mg of thiotepa was administrated weekly after surgery for five times. The local progression-free survival (PFS), CSFd-free survival (CFS), and overall survival (OS) were compared in these four groups. Results: Group C and D patients showed significantly longer PFS than Group A and B (p < 0.0001), suggesting the clinical significance of HdI for local control of this tumor. On the other hand, CFS in Group B and D was significantly longer than that in Group A and C (p = 0.049), demonstrating the effect of iT for prevention of CSFd. However, significant improvement of OS on the conventional treatment (Group A, median OS: 12.3 months) was observed only in Group D (median OS: 30.2 months, p = 0.002) and not in Group B or C (24 months, p = 0.135, and 14.9 months, p = 0.481 respectively). Conclusions: These data indicated that both of local control and prevention of CSFd were required for better survival of patients with GBM, and iT concurrent with HdI may be one of the treatments that fill these requirements.

No significant financial relationships to disclose.

Intestinal villus histological alterations in piglets fed dietary charcoal powder including wood vinegar compound liquid

To investigate the effects of dietary charcoal powder including wood vinegar compound liquid (CWVC, 4 : 1) on intestinal villus histology, piglets were fed 0, 1, 3 and 5% dietary CWVC diets for 30 days. Feed intake and body weight gain were measured during the experimental period. At the end of the experiments, intestinal villus height, epithelial cell area and cell mitosis were examined using light microscopy (LM), and the duodenal villus tip surface was observed using scanning electron microscopy (SEM). Feed efficiency tended to be improved in the CWVC group. The 3% CWVC group showed the highest value, followed by 1% CWVC group of most LM parameters in most intestinal parts, but the 5% CWVC group showed the almost similar value compared with the control. In addition, on the duodenal villus tip surface, the 3% CWVC group showed a clearer cell outline, larger cells and cells protuberated further into the lumen than those of the 1% CWVC group. However, the 5% CWVC group showed faint SEM features than the 1% CWVC group. The present trend of improved feed efficiency after feedings of dietary CWVC demonstrates that the CWVC could be incorporated into piglet diets up to 3% level, and that the CWVC might activate intestinal functions both at villus and cellular levels.