Clinical and experimental results of photodynamic therapy in neurosurgery

摘要

Abstract: Since 1984, 58 patients bearing malignant brain tumors were treated 70 times with photodynamic treatment (PDT). The patient population consisted of 11 primary glioblastoma WHO grade IV, 39 recurrent glioblastomas, 3 malignant meningiomas, 3 recurrent melanomas, and 2 metastasis of carcinomas. The patients were sensitized with hematoporphyrin derivative (HPD) 2.5 mg/bodyweight 24 - 48 hours prior to craniotomy and tumor resection. The light-irradiation was performed by an Argon pumped dye laser (Aurora M) superficially and/or interstitially at a dose ranging up to 250 J/cm$+2$/. The median survival of primary glioblastomas was 19 months and for recurrent glioblastomas 7 months, respectively. Malignant meningiomas, as well as melanomas, did not benefit from PDT, whereas one patient with a metastasis of an adenocarcinoma is still recurrence free since 18 months, the other recurred after 6 months. HPD extractions of the tumor revealed significantly different concentrations among the various tumors, but also between identical histologies. The survival, however, did not correlate with the HPD concentration in the tumor. PDT prolongs median survival of primary glioblastomas significantly, and doubles the survival of recurrent high grade gliomas. Furthermore the treatment of recurrent low grade gliomas and metastasis to the brain are promising indications for PDT. !5