Combining intraoperative carmustine wafers and Stupp regimen in multimodal first-line treatment of primary glioblastomas

Abstract

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.

Keywords::

• carmustine wafers
• glioblastoma
• Stupp regimen
• survival

Acknowledgments

These physicians are greatly acknowledged (in alphabetical order): Felipe Andreiuolo, Françine Chassoux, Myriam Edjlali-Goujon, Anne Fustier, Sylvie Godon-Hardy, Maria Koziak, Elisabeth Landré, Michael Mann, Eric Méary, Charles Mellerio, Catherine Miquel, Olivier Naggara, Catherine Oppenheim, Céline Pallud, Matthew D. Potts, François-Xavier ROUX, Denis Trystram.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary materials available online

Supplemental Tables I and II.