Abstract
Anticonvulsant therapy is usually recommended before surgery in all patients affected by high grade glioma who are planned to be treated with Carmustine 1,3-bis [2 chloroetyl]-1-nitrosurea, or BCNU) wafers. In fact, phase III studies have reported a risk of seizures higher than 30% in this group of patients. The aim of the study was the evaluation of rate type time of occurrence of seizures in BCNU-treated patients in the postoperative period as well as the investigation into possible risk factors for seizure occurrence in this population. From April 2007 to September 2010, 55 patients underwent surgical removal of malignant glioma and BCNU wafers implantation at the Department of Neurosurgery of Padova. All patients were given antiepileptic prophylaxis for 3 months after surgery. Clinical data (including preoperative seizure history), radiological data, surgical treatment, antiepileptic treatment were retrospectively reviewed. Nine percent of the patients treated with BCNU wafers presented seizures in the postoperative course. Seizures were partial in 80% of cases; they occurred within 30 days after surgery and in 80% of cases within the first 7 days. Patients with preoperative seizures presented more frequently postoperative epilepsy than patients who were preoperatively seizure-free [P = 0.0006; OR = 48 (2,4;945)]. Postoperative seizures were more common among patients affected by one or more wafers related adverse event than among patients without adverse events [P = 0.006; OR = 21 (2,06;213)]; however, they did not appear associated to the number of implanted wafers. Patients with a sub-therapeutic level of AED at the seventh day after surgery presented a higher seizure occurrence [P = 0.02; OR = 11 (1,5;79,8)]. In our experience, postoperative seizures in BCNU-treated patients were less frequent than expected. Careful patient selection and postoperative monitoring could probably play a role in order to decrease seizure occurrence.
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References
Sabel M, Giese A (2008) Safety profile of carmustine wafers in malignant glioma: a review of controlled trials and a decade of clinical experience. Curr Med Res Opin. doi:10.1185/03007990802508180
Glantz MJ, Cole BF, Forsyth PA et al (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the quality standards subcommittee of the American academy of neurology. Neurology 54:1886–1893
van Breemen MS, Wilms EB, Vecht CJ (2007) Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:421–430
Brem H, Piantadosi S, Burger PC, Walker M, Selker R, Vick NA, Black K, Sisti M, Brem S, Mohr G, Muller P, Morawetz R, Clifford Schold S (1995) Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain tumor treatment group. Lancet 345:1008–1012
Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, Whittle IR, Jääskeläinen J, Ram Z (2003) A Phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro-Oncology 5:79–88
Asher AL (2007) Prospective analysis of temozolomide as adjuvant to Gliadel and radiation in newly diagnosed malignant glioma. Abstract presented at the Annual Meeting of the American Association of Neurological Surgeons, Washington 2007
Attenello FJ, Mukherjee D, Datoo G, McGirt MJ, Bohan E, Weingart JD, Olivi A, Quinones-Hinojosa A, Brem H (2008) Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: a 10-year institutional experience. Ann Surg Oncol 15:2887–2893
Dal Pan G, Butler L, Schactman M (1997) Preliminary analysis of the GLIADEL treatment protocol. Abstract presented at the ASCO Annual Meeting, Atlanta 1997
Darakchiev BJ, Albright RE, Breneman JC, Warnick RE (2008) Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme. J Neurosurg 108:236–242
Giese A, Bock H.C., Kantelhardt S.R., Rohde V. (2010): Risk Management in the Treatment of Malignant Gliomas with BCNU Wafer Implants. Cent Eur Neurosurg. doi:10.1055/s-0029-1242775
Gonza′lez Vidal D (2006) The safety of Gliadel implants during the indication period in recurrent surgery in the treatment of glioblastoma multiforme [abstract]. Neurocirugıa 17:77–78
Gururangan S, Cokgor L, Rich JN, Edwards S, Affronti ML, Quinn JA, Herndon JE II, Provenzale JM, McLendon RE, Tourt-Uhlig S, Sampson JH, Stafford-Fox V, Zaknoen S, Early M, Friedman AH, Friedman HS (2001) Phase I study of Gliadel wafers plus temozolomide in adults with recurrent supratentorial high-grade gliomas. Neuro-Oncology 3:246–250
Kleinberg LR, Weingart J, Burger P, Carson K, Grossman SA, Li K, Olivi A, Wharam MD, Brem H (2004) Clinical course and pathologic findings after Gliadel and radiotherapy for newly diagnosed malignant glioma: implications for patient management. Cancer Invest 22:1–9
McGirt MJ, Than KD, Weingart JD, Chaichana KL, Attenello FJ, Olivi A, Laterra J, Kleinberg LR, Grossman SA, Brem H, Quiñones-Hinojosa A (2009) Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg Mar 110:583–588
McGovern PC, Lautenbach E, Brennan PJ, Lustig RA, Fishman NO (2003) Risk factors for post-craniotomy surgical site infection after 1, 3-bis(2-chloroethyl)-1-nitrosourea (Gliadel) wafer placement. Clin Infect Dis 36:759–765
Pan E, Mitchell SB, Tsai JS (2008) A retrospective study of the safety of BCNU wafers with concurrent temozolomide and radiotherapy and adjuvant temozolomide for newly diagnosed glioblastoma patients. J Neurooncol 88:353–357
Subach BR, Witham TF, Kondziolka D, Lunsford LD, Bozik M, Schiff D (1999) Morbidity and survival after 1, 3-bis(2-chloroethyl)-1-nitrosourea wafer implantation for recurrent glioblastoma: a retrospective case matched cohort series. Neurosurgery 45:17–22
Tait MJ, Critchley GR (2006) Experience of revision craniotomy for debulking of high grade gliomas in 27 patients in a single UK centre, with and without insertion of carmustine wafers. Meeting of the Society of British Neurosurgeons, Preston
Weingart J, Grossman SA, Carson KA, Fisher JD, Delaney SM, Rosenblum ML, Olivi A, Judy K, Tatter SB, Dolan ME (2007) Phase I trial of polifeprosan 20 with carmustine implant plus continuous infusion of intravenous O6-benzylguanine in adults with recurrent malignant glioma: new approaches to brain tumor therapy CNS consortium trial. J Clin Oncol 25:399–404
Della Puppa A, Rossetto M, Ciccarino P, Del Moro G, Rotilio A, Manara R, Gardiman MP, Denaro L, d’Avella D, Scienza R (2010) The first 3 months after BCNU wafers implantation in high-grade glioma patients: clinical and radiological considerations on a clinical series. Acta Neurochir (Wien) 152:1923–1931. doi:10.1007/s00701-010-0759-6
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This work was supported in part by Grant Ricerca Sanitaria Finalizzata 285/08 of Regione Veneto.
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Della Puppa, A., Denaro, L., Rossetto, M. et al. Postoperative seizure in high grade glioma patients treated with BCNU wafers. A mono-institutional experience. J Neurooncol 105, 275–280 (2011). https://doi.org/10.1007/s11060-011-0577-6
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DOI: https://doi.org/10.1007/s11060-011-0577-6