Boron Neutron Capture Therapy in the Treatment of GlioblastomaMultiformeThe First Experiences in the Czech Republic

Overview

Background.
Glioblastoma multiforme is the most frequent primary brain tumor in adults. Despite advances insurgery, radiotherapy and chemotherapy, its treatment remains unsatisfactory with very limited overall survival. Inthe year 2001, in cooperation with Department of Neurosurgery, Nemocnice Na Homolce and Nuclear ResearchInstitute in Rez, we have started to treat glioblastoma patients with boron neutron capture therapy (BNCT).Methods and Results. Cells of malignant brain tumors, especially that of glioblastomas, are able to accumulateboron compounds. If BNCT should be successful, it is necessary to reach selective accumulation of sufficient amountof 10B in the tumor and low accumulation in the normal brain tissue. After BSH administration, radiation with lowenergy thermal neutrons is delivered. It results in nuclear capture and fission reactions with subsequent selectivedamage of tumor cells. At the time of analysis 9 patients have been enrolled. Therapy was completed in 5 patients.Treatment has been very well tolerated. We observed minimal acute toxicity associated with radiation and nolaboratory abnormalities after administrations of BSH. Unfortunately treatment results were quite unsatisfactory.The median time to progression and overall survival were shorter then expected with conventional treatment.Conclusions. BNCT is very well tolerated with only a modest toxicity. In contrast to standard radiation, BNCTpatients receive only one dose of radiation. Nevertheless, in this small pilot study first results were inferior whencompared either to outcomes of conventional therapy or to results reported from other BNCT groups. It might beexplained that lower dose of radiation had been used. Further study will show whether the higher dose radiation canimprove treatment results.

Key words:
glioblastoma multiforme, BSH, neutron capture therapy.