PROTEOLYSIS INHIBITORS IN THE CEREBROSPINAL FLUID OF PATIENTS WITH MALIGNANT GLIOMAS AFTER TWO KINDS OF LOCAL INTRAOPERATIVE CHEMOTHERAPY

Cerebrospinal fluid (CSF) studied in 52 patients operated for malignant gliomas (T2-3NxMo) to study the acute-phase 2-macroglobulin (2M) and 1-proteinase inhibitor (-1PI) after two types of local intraoperative chemotherapy (LICT-1 and LICT-2). 2M and determined to -1PI before LICT (background) as well as on the 7th day after 1 and 2 months of post-operative period (p/o) using standard ELISA tests. Liquor of 9 patients with no inflammatory or malignant process in the brain served as control. Gender and age differences in the cerebrospinal fluid have not been established. After each method of treatment there were different response in patients after LICT, so patients were separated into groups with unfavorable and favorable postoperative period. On POD 7 after LICT-1 and LICT-2 ingroups with an unfavorable postoperative period 2M in both types of treatment was significantly lower than in both groups with a favorable postoperative period. -1PI on POD 7 after LICT-1 and2 inthe groups with negative dynamics was significantly higher than in the groups with positive dynamics and in samples before LICT and in control group. Two months after LICT-1 in18.5% of 27 patients had continued growth of the tumor with a fatal outcome, the remaining survivors the activity of 2M remained high. Two months after LICT-2 2M in samples of liquor decreased relative to the previous period and the samples before LICT (p <0.01 inall cases), while it remained significantly higher to control samples; there were no deaths registered during this period. After 2 months -1PI in the cerebrospinal fluid of patients with negative dynamics after LICT-1 remained higher than in control samples by 38.8%, and after LICT-2 it was lower by 24.1%. In both groups with positive dynamics α-1PI matched conditional normal value in the control group. Persisting of a high inhibitory capacity of liquor or its reduction below the conventional standards demonstrates local inflammation, or the possibility of continued tumor growth and can serve as a predictor for the early detection of the severity of the patient's condition in p/o period. LICT-2 was more successful because all the patients survived, neurological deficit wasn’t observed.

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