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Combined Fluorescence-Guided Resection and Intracavitary Thermotherapy with Superparamagnetic Iron-Oxide Nanoparticles for Recurrent High-Grade Glioma: Case Series with Emphasis on Complication Management
SIMPLE SUMMARY: Recurrent high-grade gliomas are difficult to treat. Here, we report on our single-center experience in combining fluorescence-guided tumor resection with 5-ALA and local thermotherapy with superparamagnetic iron nanoparticles. In total, 18 patients were operated on and received ther...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833446/ https://www.ncbi.nlm.nih.gov/pubmed/35158809 http://dx.doi.org/10.3390/cancers14030541 |
Sumario: | SIMPLE SUMMARY: Recurrent high-grade gliomas are difficult to treat. Here, we report on our single-center experience in combining fluorescence-guided tumor resection with 5-ALA and local thermotherapy with superparamagnetic iron nanoparticles. In total, 18 patients were operated on and received thermotherapy with or without additional radiotherapy. The median progression-free survival was 5.5 months and median overall survival was 9.5 months. Although no major side effects were observed during active treatment, 72% of the patients developed cerebral edema requiring steroid treatment or even surgical removal of the nanoparticles. In conclusion, the combination of fluorescence-guided resection and intracavitary thermotherapy provides a novel and promising treatment option for improving local tumor control in recurrent high-grade gliomas, but further refinements of the treatment protocol are needed to decrease major side effects. ABSTRACT: Background: Concepts improving local tumor control in high-grade glioma (HGG) are desperately needed. The aim of this study is to report an extended series of cases treated with a combination of 5-ALA-fluorescence-guided resection (FGR) and intracavitary thermotherapy with superparamagnetic iron oxide nanoparticles (SPION). Methods: We conducted a single-center retrospective review of all recurrent HGG treated with FGR and intracavitary thermotherapy (n = 18). Patients underwent six hyperthermia sessions in an alternating magnetic field and received additional adjuvant therapies on a case-by-case basis. Results: Nine patients were treated for first tumor recurrence; all other patients had suffered at least two recurrences. Nine patients received combined radiotherapy and thermotherapy. The median progression-free survival was 5.5 (95% CI: 4.67–6.13) months and median overall survival was 9.5 (95% CI: 7.12–11.79) months. No major side effects were observed during active treatment. Thirteen patients (72%) developed cerebral edema and more clinical symptoms during follow-up and were initially treated with dexamethasone. Six (33%) of these patients underwent surgical removal of nanoparticles due to refractory edema. Conclusions: The combination of FGR and intracavitary thermotherapy with SPION provides a new treatment option for improving local tumor control in recurrent HGG. The development of cerebral edema is a major issue requiring further refinements of the treatment protocol. |
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