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Rapid regression of glioblastoma following carmustine wafer implantation: A case report.

Al's Comment:

 You can never make decisions based on individual case reports but they are nice to see.  Gliadel has been neglected by some medical centers.  On average, it adds a little extra time before the tumor progresses, sometimes allowing time for other treatments to have a chance at working. It was never meant to be a cure by itself.  We do not have enough patients in our brain tumor virtual trial (virtualtrials.com) to make a statistically significant statement about it, but taking a look at just our  long term (over 5 year) GBM survivors,  5 out of the 21 (24%) have used Gliadel as part of the plan. Looking at all GBM patients, 36 out of 469 (8%) have used Gliadel. To me this means that if Gliadel had no effect, you would expect the same % of patients who used it as the % of long term survivors who use it. But we see a tripling of the %, which means Gliadel does have a big increase (possibly tripling) in the chances of becoming a long term survivor, and it should be studied more in depth.

 


Posted on: 06/29/2016

Mol Clin Oncol. 2016 Jul;5(1):153-157. Epub 2016 May 10.
Rapid regression of glioblastoma following carmustine wafer implantation: A case report.
Fukai J1, Nishibayashi H1, Uematsu Y2, Kanemura Y3, Fujita K1, Nakao N1.
 
Author information:
1Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama 641-0012, Japan.
2School of Health and Nursing Science, Wakayama Medical University, Wakayama, Wakayama 641-0011, Japan.
3Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Osaka 540-0006, Japan.
 
Abstract
 
Carmustine wafers, which are locally delivered chemotherapy in the form of biodegradable implants, confer a survival benefit to patients with glioblastoma (GB) following surgical resection. While the adverse events of this method, including gas retention and perifocal edema, have been extensively investigated, the immediate efficacy of the implant has rarely been reported. To the best of our knowledge, this is the first reported case of GB in which the tumor rapidly regressed after partial surgical removal followed by implantation of carmustine wafers. A 77-year-old woman presented with motor aphasia and right hemiparesis. Neuroimaging revealed a tumor located in the left frontal lobe of the brain. The tumor was partially removed under 5-aminolevulinic acid fluorescence guidance and 8 carmustine wafers were implanted in the resection cavity. The histopathological findings suggested the diagnosis of GB. Genetic and immunohistochemical analyses revealed O 6-methylguanine-DNA methyltransferase (MGMT) gene promoter methylation and low MGMT protein expression, respectively, in the tumor cells. One month after the operation, when adjuvant temozolomide chemotherapy was planned, computed tomography and magnetic resonance imaging revealed a marked regression of the residual tumor and perifocal edema. The patient's symptoms and signs had improved. As adjuvant temozolomide without radiation was therapeutically beneficial, the tumor gradually regressed and the patient has remained progression-free for >12 months after the operation. Therefore, adjuvant local chemotherapy with carmustine wafer implants was able to induce rapid regression of GB.
PMID: 27330789 [PubMed]

 


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