The chemotherapy protocols used in conjunction with BBBD involve both intraarterial and intravenous chemotherapy.
The patients are given leucovorin 80 mg intravenous once and then 50 mg orally every six hours for 20 doses (five days) following BBBD treatment.
In arm I, patients receive radiation therapy followed by chemotherapy + BBBD; in arm II, patients receive chemotherapy + BBBD followed by radiation therapy.
If the patient meets eligibility criteria, the clinical nurse coordinators explain the details of the BBBD procedure, monthly hospitalizations, follow-up testing, risks and potential adverse effects of BBBD and chemotherapy, to patients and their significant others.
Patients are admitted to the hospital the afternoon preceding the first BBBD treatment since numerous interventions are necessary prior to undergoing the disruption procedure.
If the patient has an elevated temperature indicating an underlying infection, the BBBD procedure is cancelled.
During the BBBD procedure, the patient receives a large dose of intraarterial mannitol.
An unexpected complication secondary to our use of carboplatin in conjunction with BBBD has been high-frequency hearing loss.
The most recent CNS lymphoma report from the OHSU program includes 58 patients with CNS lymphoma treated with BBBD chemotherapy using methotrexate, cytoxan, procarbazine and dexamethasone.
The patient underwent BBBD plus methotrexate tri-drug chemotherapy regimen beginning March, 1993.
Of the 16 patients with PNET who have been treated with BBBD plus carboplatin-based chemotherapy, 11 (62%) had an objective radiographic response including nine complete responses and two partial responses.
It is evident that PNETs respond initially to carboplatin-based chemotherapy with BBBD.