Combining intraoperative carmustine wafers and Stupp regimen in multimodal first-line treatment of primary glioblastomas.
BACKGROUND
The study investigated if intraoperative use of carmustine wafers, particularly in combination with Stupp regimen, is a viable and safe first-line treatment option of glioblastomas.


METHODS
Eighty-three consecutive adult patients (50 men; mean age 60 years) with newly diagnosed supratentorial primary glioblastomas that underwent surgical resection with intraoperative carmustine wafers implantation (n = 7.1 ± 1.7) were retrospectively studied.


RESULTS
The median overall survival (OS) was 15.8 months with 56 patients dying over the course of the study. There was no significant association between the number of implanted carmustine wafers and complication rates (four surgical site infections, one death). The OS was significantly longer in Stupp regimen patients (19.5 months) as compared with patients with other postoperative treatments (13 months; p = 0.002). In addition patients with eight or more implanted carmustine wafers survived longer (24.5 months) than patients with seven or less implanted wafers (13 months; p = 0.021). Finally, regardless of the number of carmustine wafers, median OS was significantly longer in patients with a subtotal or total resection (21.5 months) than in patients with a partial resection (13 months; p = 0.011).


CONCLUSIONS
The intraoperative use of carmustine wafers in combination with Stupp regimen is a viable first-line treatment option of glioblastomas. The prognostic value of this treatment association should be evaluated in a multicenter trial, ideally in a randomized and placebo-controlled one.
a Department of Neurosurgery , Sainte-Anne Hospital , Paris , France.
Vladislav
V
Pavlov
Philippe
P
Page
Georges
G
Abi-Lahoud
François
F
Nataf
Edouard
E
Dezamis
Audrey
A
Robin
Pascale
P
Varlet
Baris
B
Turak
Frédéric
F
Dhermain
Julien
J
Domont
Guillaume
G
Louvel
Raphaëlle
R
Souillard-Scemama
Eduardo
E
Parraga
Jean-François
JF
Meder
Fabrice
F
Chrétien
Bertrand
B
Devaux
Johan
J
Pallud
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000494:pharmacology; D024221:Antineoplastic Protocols; D002330:Carmustine / Q000008:administration & dosage / Q000494:pharmacology; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015173:Supratentorial Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D055815:Young Adult
D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine
Stupp regimen; carmustine wafers; glioblastoma; survival