Preirradiation osmotic blood-brain barrier disruption plus combination chemotherapy in gliomas: quantitation of tumor response to assess chemosensitivity.

Twelve adults (11 male, 1 female), diagnosed as having supratentorial gliomas, were treated with osmotic blood-brain barrier disruption and chemotherapy (intra-arterial methotrexate, 2500 mg/infusion; intravenous Cytoxan, 15 mg/kg/infusion; and oral procarbazine, 100 mg daily x 14 days) prior to radiotherapy. To assess higher cortical function, all patients underwent neuropsychological testing. Volumetric analysis of pretreatment and serial enhanced computerized tomographic scans were recorded. Four of ten patients with enhancing tumor showed radiographic tumor response, defined as 50% reduction of enhancing tumor volume. These four patients received no steroids at the time of maximum tumor response. Osmotic blood-brain barrier disruption and chemotherapy administered prior to radiotherapy can result in significant objective tumor responses with maintenance of cognitive function. It also offers a new and unique means to assess chemosensitivity, which may lead to improved treatment protocols.