title: Safety and Effectiveness of Bis-Chloroethylnitrosourea Wafer Chemotherapy in Elderly Patients with Recurrent Glioblastoma.
abstract: OBJECTIVE
  To assess the safety and effectiveness of bis-chloroethylnitrosourea (BCNU) wafers in elderly patients with recurrent glioblastoma (GBM).
  
  
  METHODS
  Patients with recurrent GBM operated on between 2007 and 2014 were divided into 3 groups: >65 years with BCNU wafer implantation, >65 years without BCNU wafer implantation, and ≤65 years with BCNU wafer implantation. We compared survival and complications.
  
  
  RESULTS
  A total of 79 patients were identified: 24 in the older BCNU group (median age 68.2 years, 33.3% with a methylated MGMT promoter), 16 in the older non-BCNU group (median age 68.6 years, 31.3% with a methylated MGMT promoter), and 39 in the younger BCNU group (median age 56.8 years). Survival after progression was 9.2 months in the elderly BCNU group and 7.6 months in the elderly non-BCNU group (p = 0.34); overall survival was 17.2 and 15.9 months, respectively (p = 0.35). We found a tendency toward a higher rate of seizures and pneumonia in the older BCNU group.
  
  
  CONCLUSIONS
  BCNU wafer implantation after resection of recurrent GBM is a reasonably safe treatment in patients aged >65 years. Seizures and systemic infections may occur more frequently, but the trade-off is still favorable as survival may be influenced positively. Higher age should not be regarded as a contraindication for BCNU wafers.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Klein
authors.forename: Tareq A
authors.initials: TA
authors.lastname: Juratli
authors.forename: Yordan
authors.initials: Y
authors.lastname: Radev
authors.forename: Dirk
authors.initials: D
authors.lastname: Daubner
authors.forename: Silke
authors.initials: S
authors.lastname: Soucek
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krex
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002330:Carmustine / Q000009:adverse effects* / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine
keywords: Bis-chloroethylnitrosourea; Carmustine; Chemotherapy; Elderly; Glioblastoma; Wafers