脑胶质瘤病人^(131)Ⅰ-chTNT单抗放射免疫治疗的临床初步应用

Preliminary Report on the Clinical Application of ^(131)Ⅰ-chTNT Monoclonal Antibody Radio-Immunotherapy in Patients with re-operated Glioma

目的:应用131Ⅰ-chTNT(131I-肿瘤细胞核人鼠嵌合单抗)通过局部化疗囊注入脑胶质瘤残瘤腔内,探讨其治疗复发性脑胶质瘤患者的临床疗效及安全性。方法:12例复发性脑胶质瘤病人,均经手术病理证实为WHO分级Ⅲ~Ⅳ。所有病人均行手术切除肿瘤后,于肿瘤残腔内放置Ommaya化疗囊,手术后2周囊内注入131Ⅰ-chTNT1110MBq,14d后重复注入一次。治疗期间对患者的一般情况、症状改善、毒副反应等进行观察和记录,并进行KPS评分;治疗前、治疗后3个月和6个月观察血常规、肝肾功能、甲状腺功能及CT和MR的肿瘤影像学变化。结果:131Ⅰ-chTNT治疗脑胶质瘤的总有效率为66.67%,CR:50%,PR:16.67%。MR和CT影像观察到有不同程度的放射性脑水肿。131Ⅰ-chTNT治疗前后血常规、肝功能、肾功能等观察指标均在正常值范围内波动,未观察到严重的肝功能损害。而甲状腺功能在治疗期间有波动。结论:131Ⅰ-chTNT通过局部化疗囊注射给药是安全、可靠的给药途径,具有疗效高、毒副反应轻的优点,是一种治疗恶性脑胶质瘤的新型放射免疫治疗制剂,值得进一步的临床使用。

Objective To study the safety and therapeutic efficacy of ^131Ⅰ-chTNT monoclonal antibody radio-immunotherapy（RIT）via intratumoral Ommaya reservoir placed during re-operation in patients with glioma.Methods Twelve patients with recarrent glioma（WHO stage Ⅲ-Ⅳ）underwent second operation（tumor de-bulking）and Ommaya reservoir was placed in the residual cavity.^131I-chimeric tumor necrosis treatment（^131Ⅰ-chTNT）monoclonal antibody 1.5ml（1110MBq）was injected into the reservoir as radio-immunotherapy two weeks after the operation and the injection was repeated another two weeks later.Blood chemistry（with hepatic,renal and thyroid functions）,brain CT and MR imaging were studied before operation,3 months and 6 months later.The karnofsky scores were noticed.Results As shown with the imaging studies,the total treatment response rate was 66.67%（CR 50% and PR 16.67%）.General condition was satisfactory and laboratory studies were within normal ranges.There were no serious untoward reactions.Conclusion Administration of ^131Ⅰ-chTNT monoclonal antibody via Ommaya reservoir as radio-immunotherapy post-operatively was safe and effective in patients with recurrent glioma.The process warranted further study.