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
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.
KeywordsCarmustine wafer Glioblastoma Karnofsky performance status Safety
Karnofsky performance status
Magnetic resonance imaging
Recursive partitioning analysis
Radiation Therapy Oncology Group
World Health Organization
These physicians are greatly acknowledged (in alphabetical order): Felipe ANDREIUOLO, Céline BOTELLA, Karl CHAMPEAUX, Francine CHASSOUX, Myriam EDJLALI-GOUJON, Raphaël GAILLARD, Sylvie GODON-HARDY, Maria KOZIAK, Elisabeth LANDRE, Laurence LEGRAND, Michael MANN, Jean-Louis MAS, Eric MEARY, Jean-François MEDER, Charles MELLERIO, Cristina MONDET, Olivier NAGARRA, François NATAF, Philippe PAGE, Mélanie PAGES, Vladislav PAVLOV, Thomas ROUJEAU, François-Xavier ROUX, Raphaëlle SOUILLARD-SCEMAMA, Arnault TAUZIEDE-ESPARIAT, Baris TURAK, Denis TRYSTRAM, Pascale VARLET.
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