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Research ArticleClinical Studies

Long-term Outcome in Patients with Recurrent Malignant Glioma Treated with Perillyl Alcohol Inhalation

CLOVIS O. DA FONSECA, RAPHAEL M. TEIXEIRA, JÚLIO CESAR T. SILVA, JULIANA DE SALDANHA DA GAMA FISCHER, OSÓRIO C. MEIRELLES, JOSE ALBERTO LANDEIRO and THEREZA QUIRICO-SANTOS
Anticancer Research December 2013, 33 (12) 5625-5631;
CLOVIS O. DA FONSECA
1Department of General and Specialized Surgery, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, RJ, Brazil
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RAPHAEL M. TEIXEIRA
2Department of Cellular and Molecular Biology, Institute of Biology, Fluminense Federal University, Niteroi, RJ, Brazil
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JÚLIO CESAR T. SILVA
3Department of Neurosurgery, Ipanema Federal Hospital, Ipanema, RJ, Brazil
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JULIANA DE SALDANHA DA GAMA FISCHER
4Laboratory for Proteomics and Protein Engineering, Carlos Chagas Institute, Fiocruz/Paraná, Curitiba, PR, Brazil
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OSÓRIO C. MEIRELLES
5Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
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JOSE ALBERTO LANDEIRO
1Department of General and Specialized Surgery, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, RJ, Brazil
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THEREZA QUIRICO-SANTOS
2Department of Cellular and Molecular Biology, Institute of Biology, Fluminense Federal University, Niteroi, RJ, Brazil
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  • For correspondence: tquirico@vm.uff.br
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    Figure 1.

    Effect of intranasal POH treatment in patients with astrocytoma grade II. Representative MRIs of AA-II patient (A) show a marked reduction of tumor size image after 2 years and 3 years of POH treatment in comparison with first image obtained before treatment. (B) Mild reduction of tumor size after 2 and 3 years of POH treatment in comparison with first image obtained before treatment.

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    Figure 2.

    Overall survival of glioma patients included in Phase I/II clinical trial. Kaplan-Meier curves show the influence of long-term treatment without discontinuation of intranasal POH administration. Comparison of primary GBM (A) and secondary GBM (p<0.0001); (B) anaplastic astrocytoma (AA) and anaplastic oligodendroglioma (p=0.0199). Line of tendency indicates survival rate of patients.

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    Figure 3.

    Effect of intranasal POH treatment in recurrent oligoastrocytoma. A patient with recurrent oligoastrocytoma and extensive peritumoral edema failed to respond to POH treatment. MRI image obtained before (A) and 4 months after POH treatment (B). A good-responder patient showed in comparison with initial MRI (C) a marked reduction (D) in the tumor size 4 years after POH treatment. HE staining (E) shows increased glomeruloid microvascular and glial cell proliferation with atipia, hypercromatism and nuclear pleomorphism. Brain biopsy fragment (F) obtained 4 years after intranasal POH treatment during intracranial drainage of hematoma shows apparently normal characteristics of glial and neuronal cellularity.

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    Figure 4.

    Effect of intranasal POH treatment in recurrent GBM. Representative brain image (MRI) of a patient with recurrent primary GBM. Decrease in the tumor size between the initial MRI (A, B) and 6 months after treatment (C, D).

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    Figure 5.

    Tumor recurrence after treatment discontinuation. Decrease in the tumor image size of a patient with secondary GBM at the time of inclusion in POH trial (A); image obtained 3 years after continuous treatment with intranasal POH (B); and image (C) obtained three months after the patient quit treatment.

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Anticancer Research: 33 (12)
Anticancer Research
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December 2013
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Long-term Outcome in Patients with Recurrent Malignant Glioma Treated with Perillyl Alcohol Inhalation
CLOVIS O. DA FONSECA, RAPHAEL M. TEIXEIRA, JÚLIO CESAR T. SILVA, JULIANA DE SALDANHA DA GAMA FISCHER, OSÓRIO C. MEIRELLES, JOSE ALBERTO LANDEIRO, THEREZA QUIRICO-SANTOS
Anticancer Research Dec 2013, 33 (12) 5625-5631;

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Long-term Outcome in Patients with Recurrent Malignant Glioma Treated with Perillyl Alcohol Inhalation
CLOVIS O. DA FONSECA, RAPHAEL M. TEIXEIRA, JÚLIO CESAR T. SILVA, JULIANA DE SALDANHA DA GAMA FISCHER, OSÓRIO C. MEIRELLES, JOSE ALBERTO LANDEIRO, THEREZA QUIRICO-SANTOS
Anticancer Research Dec 2013, 33 (12) 5625-5631;
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Keywords

  • phase II trial
  • perillyl alcohol
  • intranasal administration
  • glioma
  • GBM
  • glioblastoma multiforme
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