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Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort.

Al's Comment:

 This article shows that adding Gliadel wafer at the time of the initial surgery for glioblastoma adds about 2 month to the progression free survival as well as to the overall survival.  2 months might now sound like a lot, but it may buy enough time for something else to work.  I am surprised that they aren't used more frequently.


Posted on: 07/18/2015

  Neuro Oncol. 2015 Jul 16. pii: nov126. [Epub ahead of print]

Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort.

Pallud J1, Audureau E1, Noel G1, Corns R1, Lechapt-Zalcman E1, Duntze J1, Pavlov V1, Guyotat J1, Hieu PD1, Le Reste PJ1, Faillot T1, Litre CF1, Desse N1, Petit A1, Emery E1, Voirin J1, Peltier J1, Caire F1, Vignes JR1, Barat JL1, Langlois O1, Dezamis E1, Parraga E1, Zanello M1, Nader E1, Lefranc M1, Bauchet L1, Devaux B1, Menei P1, Metellus P1; Club de Neuro-Oncologie of the Société Française de Neurochirurgie.
 
Author information:
1Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (J.P., V.P., E.D., E.P., M.Z., B.D.); Paris Descartes University, Paris, France (J.P., V.P., E.D., E.P., M.Z., B.D.); Department of Histopathology and Animal Models, Institut Pasteur, Paris, France (J.P.); Réseau d'Etude des Gliomes (REG), France (J.P., L.B.); Public Health Department, Henri Mondor Teaching Hospital, Créteil, France (E.A.); Laboratoire d'Investigation Clinique, Université Paris Est Créteil, Créteil, France (E.A.); Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, Strasbourg, France (G.N.); Radiobiology Laboratory, Federation of Translationnal Medicine de Strasbourg (FMTS), Strasbourg University, Strasbourg, France (G.N.); Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom (R.C.); Department of Pathology, Caen University Hospital, Caen, France (E.L.-Z.); CNRS, UMR 6232 CERVOxy Group, Caen, France (E.L.-Z.); University of Caen Basse-Normandie, UMR 6232 CERVOxy Group, Caen, France (E.L.-Z.); CEA, UMR 6232 CERVOxy Group, Caen, France (E.L.-Z.); Department of Neurosurgery, Maison Blanche Hospital, Reims University Hospital, Reims, France (J.D., C.-F.L.); Service of Neurosurgery D, Lyon Civil Hospitals, Pierre Wertheimer Neurological and Neurosurgical Hospital, Lyon, France (J.G.); Department of Neurosurgery, Faculty of Medicine, University Medical Center, University of Brest, Brest, France (P.D.H.); Department of Neurosurgery, University Hospital Pontchaillou, Rennes, France (P.-J.L.R.); Department of Neurosurgery, APHP Beaujon Hospital, Clichy, France (T.F.); Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon, France (N.D.); Department of Neurosurgery, University Hospital Jean Minjoz, Besançon, France (A.P.); Departement of Neurosurgery, University Hospital of Caen, University of Lower Normandy, Caen, France (E.E.); Department of Neurosurgery, Pasteur Hospital, Colmar, France (J.V.); Department of Neurosurgery, Hautepierre Hospital, Strasbourg, France (J.V.); Department of Neurosurgery, Amiens University Hospital, Amiens, France (J.P., M.L.); Service de Neurochirurgie, CHU de Limoges, Limoges, France (F.C.); Service de Neurochirurgie A, CHU Pellegrin, Bordeaux Cedex, France (J.-R.V.); Department of Neurosurgery, Clairval Private Hospital, Marseille, France (J.-L.B., P.M.); Department of Neurosurgery, Rouen University Hospital, Rouen, France (O.L.); Department of Neurosurgery, CHU d'Angers, Angers, France (E.N., P.M.); Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France (L.B.); UMR911, CRO2, Aix-Marseille Université, Marseille, France (P.M.).
 
Abstract
BACKGROUND:
 
The standard of care for newly diagnosed glioblastoma is maximal safe surgical resection, followed by chemoradiation therapy. We assessed carmustine wafer implantation efficacy and safety when used in combination with standard care.
METHODS:
 
Included were adult patients with (n = 354, implantation group) and without (n = 433, standard group) carmustine wafer implantation during first surgical resection followed by chemoradiation standard protocol. Multivariate and case-matched analyses (controlled propensity-matched cohort, 262 pairs of patients) were conducted.
RESULTS:
 
The median progression-free survival was 12.0 months (95% CI: 10.7-12.6) in the implantation group and 10.0 months (9.0-10.0) in the standard group and the median overall survival was 20.4 months (19.0-22.7) and 18.0 months (17.0-19.0), respectively. Carmustine wafer implantation was independently associated with longer progression-free survival in patients with subtotal/total surgical resection in the whole series (adjusted hazard ratio [HR], 0.76 [95% CI: 0.63-0.92], P = .005) and after propensity matching (HR, 0.74 [95% CI: 0.60-0.92], P = .008), whereas no significant difference was found for overall survival (HR, 0.95 [0.80-1.13], P = .574; HR, 1.06 [0.87-1.29], P = .561, respectively). Surgical resection at progression whether alone or combined with carmustine wafer implantation was independently associated with longer overall survival in the whole series (HR, 0.58 [0.44-0.76], P < .0001; HR, 0.54 [0.41-0.70], P < .0001, respectively) and after propensity matching (HR, 0.56 [95% CI: 0.40-0.78], P < .0001; HR, 0.46 [95% CI: 0.33-0.64], P < .0001, respectively). The higher postoperative infection rate in the implantation group did not affect survival.
CONCLUSIONS:
 
Carmustine wafer implantation during surgical resection followed by the standard chemoradiation protocol for newly diagnosed glioblastoma in adults resulted in a significant progression-free survival benefit.

 


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