显微手术切除联合间质内树状突细胞疫苗治疗复发脑胶质瘤

Treatment of recurrent brain gliomas by microsurgical excision combined with interstitial vaccination of dendritic cells

目的：探讨显微外科手术切除联合间质内树状突细胞（dendritic cells，DC）疫苗治疗复发脑胶质瘤的临床疗效和安全性。方法：对8例复发脑胶质瘤患者行开颅显微手术全切除，术中瘤腔内安置Ommaya囊，术后从复发瘤组织分离培养出脑肿瘤干细胞（brain tumor stem cells，BTSC），制备个体特异性DC疫苗，术后4W、6W、8W、10W、12W经由Ommaya囊行瘤腔内自体免疫治疗。随访6—15个月，观察治疗效果。结果：8例患者均获随访，3个月无复发，无死亡；6个月复发3例，死亡1例，生存期明显延长。全部患者均无明显的不良反应，生存质量得到明显改善。结论：显微手术力争全切除，术后联合间质内BTSC抗原脉冲DC疫苗自体免疫治疗，是一种靶向BTSC治疗复发脑胶质瘤的安全有效方法。

Objective ： To investigate the safety and efficacy of treatment of recurrent brain gliomas by surgical excision combined with interstitial vaccination of dendritic cells （DC）. Methods： In 8 patients with recurrent brain gliomas, the tumor was microsurgically removed and initial Ommaya bursa were embeded in the tumor bed during operation. Tumor tissues from eight cases of recurrent malignant brain gliomas were used for primary cell culture. After the primary brain tumor spheres generated,they were triturated again and passaged in freshed medium. Glioma tissue contained brain tumor stem cells （BTSC） were isolated in vitro. Individual vaccination was made of DC loaded with autologous BTSC lysate-pulsed. Postoperation 4,6,8,10,12 weeks, patients were received autologus DC vaccination by intra-Ommaya. The patients were followed up for 6 - 15 months, and the results of treatment were evaluated. Results： All of the 8 patients were followed up. At 3 months after treatment,there were no recurrent and mortality. After 6 months, recurrent is 3 of 8 and survival is 7 of 8, life time extended. All the patients had no apparent side-effects and life quality were improved. Conclusion： Microsugical resection combined with interstitial autologus immunotherapy by BTSC lysate-pulsed dendritic cells is the safe and effective method of targeting BTSC for recurrent brain gliomas.