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Extent of resection and Carmustine wafer implantation safely improve survival in patients with a newly diagnosed glioblastoma: a single center experience of the current practice.

Al's Comment:

Extent of resection and Carmustine wafer implantation safely improve survival in patients with a newly diagnosed glioblastoma: a single center experience of the current practice.         Gliadel wafer is a biodegradable implant that slowly releases chemotherapy at the tumor site.  It was approved on 1995 and it's popularity has waned. One of the main reasons is that many clinical trials said that using Gliadel wafer makes you ineligible for the trials.  Some major brain tumor centers use this routinely on everyone who has a glioblastoma surgery, and others almost never use it.  It is worth asking your surgeon about.  This report shows that it is associated with longer progression free survival and overall survival.


Posted on: 07/06/2017

J Neurooncol. 2017 Jul 1. doi: 10.1007/s11060-017-2551-4. [Epub ahead of print]

Extent of resection and Carmustine wafer implantation safely improve survival in patients with a newly diagnosed glioblastoma: a single center experience of the current practice.

Roux A1,2, Peeters S1,2,3, Zanello M1,2, Bou Nassif R1,2, Abi Lahoud G1,2, Dezamis E1,2,4, Parraga E1,2, Lechapt-Zalcmann E2,5, Dhermain F6, Dumont S7, Louvel G6, Chretien F2,5, Sauvageon X2,8, Devaux B1, 2, Oppenheim C2,4,9, Pallud J10,11,12.
 
Author information:
 
1
    Department of Neurosurgery, Service de Neurochirurgie, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France.
2
    Paris Descartes University, Sorbonne Paris Cité, Paris, France.
3
    University of Texas Southwestern Medical Center, Dallas, TX, USA.
4
    Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
5
    Department of Neuropathology, Sainte-Anne Hospital, Paris, France.
6
    Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France.
7
    Department of Neurooncology, Gustave Roussy, Villejuif, France.
8
    Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France.
9
    Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.
10
    Department of Neurosurgery, Service de Neurochirurgie, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France. j.pallud@ch-sainte-anne.fr.
11
    Paris Descartes University, Sorbonne Paris Cité, Paris, France. j.pallud@ch-sainte-anne.fr.
12
    Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France. j.pallud@ch-sainte-anne.fr.
 
Abstract
 
For newly diagnosed glioblastomas treated with resection in association with the standard combined chemoradiotherapy, the impact of Carmustine wafer implantation remains debated regarding postoperative infections, quality of life, and feasibility of adjuvant oncological treatments. To assess together safety, tolerance and efficacy of Carmustine wafer implantation and of extent of resection for glioblastoma patients in real-life experience. Observational retrospective monocentric study including 340 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent surgical resection with (n = 123) or without (n = 217) Carmustine wafer implantation as first-line oncological treatment. Carmustine wafer implantation and extent of resection did not significantly increase postoperative complications, including postoperative infections (p = 0.269, and p = 0.446, respectively). Carmustine wafer implantation and extent of resection did not significantly increase adverse events during adjuvant oncological therapies (p = 0.968, and p = 0.571, respectively). Carmustine wafer implantation did not significantly alter the early postoperative Karnofsky performance status (p = 0.402) or the Karnofsky performance status after oncological treatment (p = 0.636) but a subtotal or total surgical resection significantly improved those scores (p < 0.001, and p < 0.001, respectively). Carmustine wafer implantation, subtotal and total resection, and standard combined chemoradiotherapy were independently associated with longer event-free survival (adjusted Hazard Ratio (aHR), 0.74 [95% CI 0.55-0.99], p = 0.043; aHR, 0.70 [95% CI 0.54-0.91], p = 0.009; aHR, 0.40 [95% CI 0.29-0.55], p < 0.001, respectively) and with longer overall survival (aHR, 0.69 [95% CI 0.49-0.96], p = 0.029; aHR, 0.52 [95% CI 0.38-0.70], p < 0.001; aHR, 0.58 [95% CI 0.42-0.81], p = 0.002, respectively). Carmustine wafer implantation in combination with maximal resection, followed by standard combined chemoradiotherapy is safe, efficient, and well-tolerated in newly diagnosed supratentorial glioblastomas in adults.

 


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