[A new treatment of malignant brain tumor -1: local injection of bleomycin (author's transl)].

: This is a paper of new trial of treatment of malignant brain tumor by local injection of bleomycin (BLM). The new method of intraneoplastic BLM injection is as follows: in the cases ended up with subtotal or partial removal of the tumor, Ommaya's device was detained in the tumor bed, and its reservoir was fixed subcutaneous on the skull. 0.1 mg/kg to 0.2 mg/kg of BLM was injected by subcutaneous puncture into the reservoir every other day. Usual total dose of BLM was 30-80 mg. The patients were usually treated with 60Co-irradiation and immunotherapy after local injection of BLM. Twelve patients with malignant brain tumor were treated by the above mentioned new method and a follow-up study was done. One-year survival rate was 50% and three-year survival rate was 25%. Each case of primary sarcoma, medulloblastoma and malignant oligodendroglioma survived for a very long time. However, most of the patients especially those with glioblastoma died of recurrence in about one year or so inspite of temporary improvement of their clinical symptoms and clinical findings. In the autopsy cases of malignant gliomas, similar pathological findings were obtained around the tumor bed. In macroscopical view, the extensive necrotic foci and small haemorrhages were observed around the tumor bed not deeper than 2 to 3 cm from the surface of the cavity, and in the deeper part the tumor tissues were actively proliferating. Microscopically there was a severe coagulation necrosis of tumor cells with haemorrhage, collagenous tissue proliferation, fibrin deposit, increasing capillary vessels and infiltrating lymphocytes and granulocytes. Consequently, the scintillation scanning of BLM labelled 57Co was utilized to make clearance curves of the drugs in the patients with malignant brain tumor. The results were as follows: 57Co-BLM activity in the tumor tissue decreased about 70% 2-4 days after local injection of the drugs, whereas, it decreased about 70% 2-4 hours after intravenous injection of the drugs. From these results it could be presumed that locally injected BLM remained in the tumor tissues for a longer time and killed malignant tumor cells completely. However, an unfavorable fact was that locally injected BLM was retained only within the tumor tissue less than 2-3 cm apart from the cavity, showing no efficacy enough to prevent tumor proliferation in more remote area. In conclusion, the local injection of BLM seems to be very effective for the treatment of malignant brain tumors if it is used together with intravenous or intraarterial injection of other chemotherapeutic drugs.