Table 4.
Strategy | Effectiveness for CNS Malignancy | Toxicity/Adverse Effects Profile | Introduction into Clinical Practice | Repeated/Continuous Administration | Tumor Size and CNS Location |
---|---|---|---|---|---|
Implantable polymers | Failed phase III clinical trials. | Invasive procedure. Increases surgical complication rates. | Relatively simple. | Not feasible. | Limited to resectable tumors at a distance from CSF pathways. |
Intracavitary drug delivery | Not established (few phase II studies). | Invasive procedure. Device-associated infections, reversible and irreversible neurotoxicity for some agents. | Limited. Requires multidisciplinary expert team approach. | Depending on the agent, may be possible for non-radioactive agents. | Limited to small tumor size or to tumors accessible for GTR |
Convection-enhanced delivery | Failed phase II/III clinical trials. Some studies are still ongoing. | Invasive procedure. Some agents associated with neurotoxity or chemical meningitis. | Limited due to high complexity. Requires multidisciplinary expert team approach. | Limited and associated with increased rate of infections. | Limited by tumor size, mass effect, and CNS location. |
Abbreviation: GTR, gross total resection.
aFor references, please see text.