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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

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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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Abbreviations

CI:

Confidence interval

HR:

Hazard ratio

KPS:

Karnofsky performance status

MRI:

Magnetic resonance imaging

OS:

Overall survival

EFS:

Event-free survival

RPA:

Recursive partitioning analysis

RTOG:

Radiation Therapy Oncology Group

WHO:

World Health Organization

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Acknowledgements

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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Authors and Affiliations

  1. Department of Neurosurgery, Service de Neurochirurgie, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris Cedex 14, France

    Alexandre Roux, Sophie Peeters, Marc Zanello, Rabih Bou Nassif, Georges Abi Lahoud, Edouard Dezamis, Eduardo Parraga, Bertrand Devaux & Johan Pallud

  2. Paris Descartes University, Sorbonne Paris Cité, Paris, France

    Alexandre Roux, Sophie Peeters, Marc Zanello, Rabih Bou Nassif, Georges Abi Lahoud, Edouard Dezamis, Eduardo Parraga, Emmanuelle Lechapt-Zalcmann, Fabrice Chretien, Xavier Sauvageon, Bertrand Devaux, Catherine Oppenheim & Johan Pallud

  3. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Sophie Peeters

  4. Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France

    Edouard Dezamis, Catherine Oppenheim & Johan Pallud

  5. Department of Neuropathology, Sainte-Anne Hospital, Paris, France

    Emmanuelle Lechapt-Zalcmann & Fabrice Chretien

  6. Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France

    Frédéric Dhermain & Guillaume Louvel

  7. Department of Neurooncology, Gustave Roussy, Villejuif, France

    Sarah Dumont

  8. Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France

    Xavier Sauvageon

  9. Department of Neuroradiology, Sainte-Anne Hospital, Paris, France

    Catherine Oppenheim

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  1. Alexandre Roux
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Correspondence to Johan Pallud.

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Roux, A., Peeters, S., Zanello, M. et al. 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. J Neurooncol 135, 83–92 (2017). https://doi.org/10.1007/s11060-017-2551-4

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