Intratumoral retrograde microdialysis treatment of high-grade glioma with cisplatin
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ORIGINAL ARTICLE - BRAIN TUMORS
Intratumoral retrograde microdialysis treatment of high-grade glioma with cisplatin Pedram Tabatabaei 1 & Thomas Asklund 2 & Per Bergström 2 & Erik Björn 3 & Mikael Johansson 2 & A. Tommy Bergenheim 1 Received: 28 April 2020 / Accepted: 6 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Purpose This study evaluates the application of a microdialysis technique for interstitial chemotherapy using cisplatin in highgrade glioma. Method An in vitro study demonstrated that cisplatin can be administered through retrograde microdialysis and defined the recovery for cisplatin. In a subsequent phase I study, 1–4 microdialysis catheters were implanted in tumor tissue, brain adjacent to tumor (BAT) tissue, and subcutaneous tissue in 10 patients with recurrent high-grade glioma. Cisplatin was administered continuously in daily doses between 0.3 and 3.9 mg for 4 to12 days. Microdialysis samples were continuously collected and analyzed for glucose metabolites, glutamate, glycerol, and cisplatin concentrations. Treatment tolerability was evaluated through clinical monitoring. Quality of life was assessed using the EORTC-QLQ-C30 questionnaire for up to 3 months after treatment. Results This in vitro study showed that cisplatin could be administrated with a recovery of 41–97%, depending on flowrate, type of catheter, and cisplatin concentration. During the treatment, patients were exposed to a total dose of 1.2–36.8 mg cisplatin. The concentration of cisplatin in BAT, serum, and subcutaneous tissue was close to detection level in all but two patients. A transient neurologic deterioration due to edema was commonly observed, but no systemic side effects were recorded. After onset of treatment, concentrations of glutamate and glycerol were significantly increased in tumor tissue but not in BAT, with a peak after 3 days, and consistent for the rest of the treatment. Five of the patients survived between 153 and 492 days after treatment. Conclusion This phase I study demonstrates that retrograde microdialysis can be used to administer cisplatin interstitially into high-grade glioma tissue. A high cytotoxicity was detected in tumor tissue, but not in the surrounding brain. Retrograde microdialysis appears to be a clinically useful method for intratumoral drug administration in high-grade glioma. Keywords Retrograde microdialysis . Malignant glioma . Cisplatin . Brain microdialysis . Interstitial . Chemotherapy
Introduction Although chemotherapy is an important component of the primary treatment of glioblastoma [20], no standard second This article is part of the Topical Collection on Brain Tumors * Pedram Tabatabaei [email protected] 1
Deparment of Clinical Sciences, Neuroscience Unit, Umeå University, 90185 Umeå, Sweden
2
Department of Neurosurgery Radiation Sciences, Umeå University, Umeå, Sweden
3
Departments of Oncology and Chemistry, Umeå University, Umeå, Sweden
line treatment has significantly improved survival. There are two major obstac
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