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
