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Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit.


Posted on: 11/21/2017

J Neurooncol. 2017 Nov 14. doi: 10.1007/s11060-017-2649-8. [Epub ahead of print]

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit.

Sage W1, Guilfoyle M1, Luney C1, Young A1, Sinha R1, Sgubin D2, McAbee JH3, Ma R4, Jefferies S5, Jena R5, Harris F5, Allinson K6, Matys T7, Qian W8, Santarius T1, Price S1, Watts C9,10.
 
Author information:
 
1
    Division of Neurosurgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK.
2
    Division of Neurosurgery, Azienda Ospedaliera Nazionale SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
3
    Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
4
    Department of Neurosurgery, John Radcliffe Hospital NHS Foundation Trust, Oxford, UK.
5
    Department of Oncology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK.
6
    Department of Histopathology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK.
7
    Department of Radiology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK.
8
    Cambridge Cancer Trial Centre, Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University NHS Foundation Trust, Cambridge, UK.
9
    Division of Neurosurgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK. cw209@cam.ac.uk.
10
    Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Hills Road, Box 167, Cambridge, CB2 0QQ, UK. cw209@cam.ac.uk.
 
Abstract
 
Grade IV glioma is the most common and aggressive primary brain tumour. Gross total resection with 5-aminolevulinic acid (5-ALA) guided surgery combined with local chemotherapy (carmustine wafers) is an attractive treatment strategy in these patients. No previous studies have examined the benefit carmustine wafers in a treatment programme of 5-ALA guided resection followed by a temozolomide-based chemoradiotherapy protocol. The objective of this study was to examine the benefit of carmustine wafers on survival in patients undergoing 5-ALA guided resection. A retrospective cohort study of 260 patients who underwent 5-ALA resection of confirmed WHO 2007 Grade IV glioma between July 2009 and December 2014. Survival curves were calculated using the Kaplan-Meier method from surgery. The log-rank test was used to compare survival curves between groups. Cox regression was performed to identify variables predicting survival. A propensity score matched analysis was used to compare survival between patients who did and did not receive carmustine wafers while controlling for baseline characteristics. Propensity matched analysis showed no significant survival benefit of insertion of carmustine wafers over 5-ALA resection alone (HR 0.97 [0.68-1.26], p = 0.836). There was a trend to higher incidence of wound infection in those who received carmustine wafers (15.4 vs. 7.1%, p = 0.064). The Cox regression analysis showed that intraoperative residual fluorescent tumour and residual enhancing tumour on post-operative MRI were significantly predictive of reduced survival. Carmustine wafers have no added benefit following 5-ALA guided resection. Residual fluorescence and residual enhancing disease following resection have a negative impact on survival.
PMID: 29139095
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