Vol.12, No 3, 2005 pp. 170 - 173
UC 616.831-006:615.849

THE APPLICATION OF SANDOSTATIN IN THERAPY OF HIGH-RISK MEDULLOBLASTOMAS
Ivan S. Stefanović1, Nebojša Stojanović1, Milorad Babić1, Dragan Stojanov2
1Neurosurgical Clinic, Clinical Center, University of Niš,
2Institute for Radiology, Clinical Center, University of Niš
  E-mail: ivanstef@EUnet.yu

Summary. The praxis of early irradiation therapy and multimodal pre- and post-irradiation chemotherapy does not significantly prolong the five-year survival time in high-risk medulloblastomas. Aim - determination of the effects of intracavitary and subcutaneous application of the long active form of Sandostatin-Octreotide in treatment of high-risk medulloblastomas of fossa cranii posterior and its metastases. Patients and methods - 11 children (7 boys and 4 girls), average age 6.7 (4-11) years, who belonged to the group of high-risk medulloblastomas according to the SIOP criteria, were operated on and Octreotide was applied intracavitarily. All were additionally treated by subcutaneous application of Sandostatin. Effects of Octreotide on the rest of the tumor and the drop metastases were determined during the following 4-7 years (average 5), by NMR, cytologic examination of cerebrospinal fluid for the presence of tumor cells and survival time.
Subcutaneous six-month application of Octreotide resulted in involution of cerebellar and all spinal drop metastases, while metastases bigger than 5mm were not significantly affected. Subcutaneous together with intracavitary application of Sandostatin inhibits the growth of medulloblastomas and leads to their involution in 2/3 of the patients with rest medulloblastoma of the cerebellum and medulla spinalis. Conversion of M1 into M0 was recorded in 8 (72.7%) cases, and a five-year survival time in 9 (81.8%) cases.
Subcutaneous application of Sandostatin for several weeks results in the apoptosis of malignant cells of medulloblastoma in a majority of patients. In loco application of Sandostatin combined with long term subcutaneous depot application can significantly inhibit the growth of medulloblastoma.
Key words: High-risk medulloblastoma, sandostatin, intracavitary and subcutaneous therapy, drop metastases


PRIMENA SANDOSTATINA U TERAPIJI VISOKORIZIČNIH MEDULOBLASTOMA
Kratak sadržaj: Rana iradijaciona terapija i multimodalitetna pre i post iradijaciona hemoterapija do sada nisu značajnije produžili petogodišnje preživljavanje u visokorizičnih meduloblastoma.
Cilj rada - procena efekta intrakavitarne i subkutane primene dugoaktivne forme Sandostatina-Octreotida u lečenju visokorizičnih meduloblastoma fose cranii posterior i njegovih metastaza.
Material i metode - jedanaestoro dece (7 dečaka, 4 devojčice), srednje starosti 6,7 godina (4-11), koji su prema SIOP kriterijumima pripadali grupi visokorizičnih meduloblastoma, operativno je lečeno, a intrakavitarno aplikovan Octreotid. Svi su dodatno tretirani subkutanom aplikacijom Sandostatina. Efekti Octreotida na rest tumora i drop metastaze određivani su narednih 4-7 godina (prosečno 5) putem NMR, citološkog pregleda likvora na prisustvo tumorskih ćelija i dužine preživljavanja.
Subkutana šestomesečna aplikacija Octreotida rezultovala je involucijom cerebelarne i svih spinalnih drop metastaza, dok na metastaze veće od 5 mm nije bitnije uticala. Subkutana aplikacija Octreotida udružena sa intrakavitarnom, suprimira rast meduloblastoma i dovodi do njegove involucije u 2/3 pacijenata sa restom meduloblastoma cerebeluma i kičmene moždine. Konverzija M1 u M0 beleži se u 8 (72,7%) tretiranih, a petogodišnje preživljavanje u 9 (81,8%).
Višenedeljna subkutana primena Sandostatina, rezultuje apoptozom malignih ćelija meduloblastoma i potpunom involucijom drop metastaza meduloblastoma u većine pacijenata. In loco primena Sandostatina kombinovana sa protrahovanom subkutanom depo aplikacijom, može značajno suprimirati rast meduloblastoma.
Ključne reči: Visokorizični meduloblastom, sandostatin, intrakavitarna i subkutana terapija, drop metastaze