Abstract
INTRODUCTION: The translational potential of convection-enhanced drug delivery (CED) for the treatment of high grade glioma (HGG) may be enhanced by the facility to perform repeated drug infusions. We report the development of an implantable catheter and transcutaneous bone-anchored port (TBAP) for intermittent CED, and its use for delivery of carboplatin in 2 patients with progressive HGG. METHOD: The feasibility of implanting the port and catheter system and performing intermittent infusions was tested in a large animal (porcine) model. Intermittent infusions of 0.2% Gadolinium-DTPA were performed at one month intervals with real-time MRI tracking by attaching a needle administration set to the port. Intermittent CED of carboplatin was performed in 2 patients with recurrent and progressive HGG (1 GBM, 1 AA). RESULTS: The porcine study confirmed the feasibility of performing intermittent CED through an implanted port and catheter system. All catheters were implanted with satisfactory accuracy, and without any haemorrhagic or infectious complications. Repeated delivery of carboplatin in a patient with recurrent GBM resulted in initial tumour regression. A second patient with progressive AA continues to show tumour control 8 months after commencing treatment. CONCLUSION: This study confirms the safety and feasibility of performing intermittent CED through a transcutaneous bone-anchored port. The use of a transcutaneous port has the potential to facilitate clinical translation of CED of therapeutics requiring intermittent delivery to achieve optimum efficacy.