Neurological Surgery 脳神経外科43巻7号

2015年07月発行

研究

悪性神経膠腫におけるギリアデル^®留置後の有害事象とその要因の検討

著者： 吉田道春¹ 山口秀¹ 伊師雪友¹ 遠藤将吾¹ 茂木洋晃¹ 小林浩之¹ 浅岡克行² 鴨嶋雄大³ 寺坂俊介¹ 寳金清博¹

所属機関： ¹北海道大学大学院医学研究科脳神経外科 ²手稲渓仁会病院脳神経外科 ³札幌麻生脳神経外科病院

ページ範囲：P.603 - P.610

Ⅰ．はじめに
　ギリアデル^®脳内留置用剤7.7mg（一般名：carmustine）は，ニトロソウレア系アルキル化剤であるcarmustineを生体内分解性ポリマー基材に含んだ脳内留置用の徐放性製剤である．組織深達度は数mmであり，脳内留置後約3〜6週間かけて徐放され，臨床用量であれば2〜14日以内に放出される^7,17)．局所化学療法であるため，全身化学療法に比べ，摘出腔表面に浸潤もしくは残存する腫瘍への直接的作用と全身毒性の回避を利点とする^8,20,23)．本邦では第Ⅰ/Ⅱ相臨床試験²⁾を経て2012年9月に国内での製造販売が承認され，2013年1月に初発および再発悪性神経膠腫に対し保険適応となった．
　初発悪性神経膠腫に対する標準治療である腫瘍摘出後放射線治療・temozolomide（TMZ）併用療法に本剤を追加することで，さらなる生命予後の改善が期待されるが^1,8,10,12)，一方で再発群に対しては脳浮腫や囊胞形成，創部治癒不全，感染などの有害事象の頻度が有意に増加したとの報告もある¹⁶⁾．
　筆者らの施設へは同年4月に導入され，悪性神経膠腫の手術治療に積極的に使用している．ギリアデル^®使用開始後の初期経験をまとめ，特にこれまで報告されている有害事象が起こりやすい要因に関して後方視的に解析して検討した．

参考文献

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