title: Outcome of patients affected by newly diagnosed glioblastoma undergoing surgery assisted by 5-aminolevulinic acid guided resection followed by BCNU wafers implantation: a 3-year follow-up.
abstract: The purpose of the study was to evaluate the clinical outcome of the association of BCNU wafers implantation and 5-aminolevulinic acid (5-ALA) fluorescence in the treatment of patients with newly diagnosed glioblastoma (ndGBM). Clinical and surgical data from patients who underwent 5-ALA surgery followed by BCNU wafers implantation were retrospectively evaluated (20 patients, Group I) and compared with data of patients undergoing surgery with BCNU wafers alone (42 patients, Group II) and 5-ALA alone (59 patients, Group III). Patients undergoing 5-ALA assisted resection followed by BCNU wafers implantation (Group I) resulted long survivors (>3 years) in 15 % of cases and showed a median PFS and MS of 11 and 22 months, respectively. Patients treated with BCNU wafers presented a significantly higher survival when tumor was removed with the assistance of 5-ALA (22 months with vs 18 months without 5-ALA, p < 0.0001); these data could be partially explained by the significantly higher CRET achieved in patients operated with 5-ALA assistance (80 % with vs 47 %% without 5-ALA). Moreover, patients of Group I showed a significant increased survival compared with Group III (5-ALA without BCNU) (22 months with vs 21 months without BCNU wafers, p = 0.0025) even with a comparable CRET (80 % vs 76 %, respectively). The occurrence of adverse events related to wafers did not significantly increase with 5-ALA (20 % with and 19 % without 5-ALA) and did not impact in survival outcome. In conclusion, our experience shows that on selected ndGBM patients 5-ALA technology and BCNU wafers implantation show a synergic action on patients' outcome without increasing adverse events occurrence.
authors.affiliation: Department of Neurosurgery, Padova University Hospital, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy. alessandro.dellapuppa@sanita.padova.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology I Unit, Veneto Institute of Oncology-IRCCS, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Department of Neurosurgery, Padova University Hospital, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rossetto
authors.affiliation: Department of Neurosurgery, Padova University Hospital, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy.
authors.forename: Oriela
authors.initials: O
authors.lastname: Rustemi
authors.affiliation: Department of Radiotherapy, IRCCS, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Berti
authors.affiliation: Department of Medicine (DIMED), Nuclear Medicine Unit, University of Padua, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchin
authors.affiliation: Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padua, Italy.
authors.forename: Marina Paola
authors.initials: MP
authors.lastname: Gardiman
authors.affiliation: Department of Neuro-Radiology, Padova University Hospital, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rolma
authors.affiliation: Oncohematology Laboratory, IRP-Istituto di Ricerca Pediatrica Città della Speranza, Department of Woman and Child Health, University of Padova, Padua, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Persano
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology I Unit, Veneto Institute of Oncology-IRCCS, Padova, Italy.
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
authors.affiliation: Department of Neurosurgery, Padova University Hospital, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D002330:Carmustine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018906:Antineoplastic Agents, Alkylating; D004343:Drug Implants; D000622:Aminolevulinic Acid; D002330:Carmustine
keywords: 5-Aminolevulinic acid (5-ALA) fluorescence; BCNU wafers; Carmustine wafers; Glioblastoma; Long survivors; Survival