Preliminary exploration of the clinical effect of bleomycin on craniopharyngiomas

Objective: To investigate the antitumor effect of bleomycin on craniopharyngiomas.

Methods: A series of cystic craniopharyngiomas were randomly divided into three groups: (A) intracystic chemotherapy with bleomycin; (B) intracystic chemo-radiotherapy with bleomycin and (32)P; (C) intracystic radiotherapy with (32)P and 0.9% saline. The agents were injected into the cysts through stereotactically inserted silicone tubes. Follow-up was done for a minimum of 6 months. Outcome was based on a comparison of the volume of cysts before treatment and at follow-up. The index and lactate dehydrogenase (LD) of the cystic fluids, blood and cerebrospinal fluids and the endocrine function of these patients were determined before and after therapy.

Results: 19 patients finished the whole therapeutic course: 5 from group A, 9 from group B and 5 from group C. Four tumors in group A were polycystic, and the drug was selectively injected into the largest cyst. At follow-up, the volumes of the cysts in groups A and B regressed from 92 to 0%, while the drug-free cysts enlarged. In group B, 6 cysts almost disappeared and another 3 regressed from 78 to 57%. In group C, one cyst progressed and the others shrank by different degrees, but none disappeared completely or nearly. All patients in groups A and B had fever of different degrees, which resolved spontaneously in 8-24 h. The complications in group B included hyponatremia in 1 patient, and both adephagia obesity and cerebral infarction in 2 patients (1 of whom died after 6 months). Apart from the oculomotor paralysis occurring in 1 patient, the remainder of group C had no other severe complications. Blood chemistry, liver, kidney, pituitary and endocrinal functions changed little during the course in all these 19 patients. LD and its isoenzymes from the cystic fluids, CSF and serum showed no marked change after bleomycin injection.

Conclusion: Bleomycin injected into cysts of craniopharyngiomas causes the tumor to shrink. When (32)P is added, the therapeutic effect seems better than treatment with either (32)P or bleomycin alone. Blood chemistry, liver, kidney and endocrine functions change little irrespective of the therapy applied. However, the combination of chemotherapy and radiotherapy may severely disturb both serum electrolytes and endocrine function. LD and its isoenzymes in the cystic fluids, CSF and serum may not change after bleomycin treatment.