Carmustine wafer implantation for supratentorial glioblastomas, IDH-wildtype in “extreme” neurosurgical conditions

Roux, Alexandre; Aboubakr, Oumaima; Elia, Angela Rita; Moiraghi, Alessandro; Benevello, Chiara; Fathallah, Houssem; Oppenheim, Catherine; Chrétien, Fabrice; Dezamis, Edouard; Zanello, Marc; Pallud, Johan

doi:10.1007/s10143-023-02052-x

Cited by 4 publications

(1 citation statement)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Elderly patients (>65 years) or patients with a poor functional status have worse prognosis and are less tolerant to toxicities. Surgical resection is not associated with improved survival [ 348 ], but according to a recent retrospective single-center study, BCNU wafer implantation during the surgical resection is safe and improves mOS 39.0 months (≥12 implanted wafers) vs. 16.5 months (<12 implanted wafers) in patients in “extreme” neurosurgical conditions (>80 years and patients with preoperative Karnofsky Performance Status score < 50) [ 349 ]. Although just a few patients (6/49) reached that number of implants, these results are impressive, since mOS in the “extreme” conditions subgroup was 10.0 months, and there was a significant improvement in the postoperative KPS score compared to the preoperative KPS score.…”

Section: Present Therapy and Challengesmentioning

confidence: 99%

Glioblastoma Therapy: Past, Present and Future

Obrador,

Moreno-Murciano,

Oriol-Caballo

et al. 2024

IJMS

View full text Add to dashboard Cite

Glioblastoma (GB) stands out as the most prevalent and lethal form of brain cancer. Although great efforts have been made by clinicians and researchers, no significant improvement in survival has been achieved since the Stupp protocol became the standard of care (SOC) in 2005. Despite multimodality treatments, recurrence is almost universal with survival rates under 2 years after diagnosis. Here, we discuss the recent progress in our understanding of GB pathophysiology, in particular, the importance of glioma stem cells (GSCs), the tumor microenvironment conditions, and epigenetic mechanisms involved in GB growth, aggressiveness and recurrence. The discussion on therapeutic strategies first covers the SOC treatment and targeted therapies that have been shown to interfere with different signaling pathways (pRB/CDK4/RB1/P16ink4, TP53/MDM2/P14arf, PI3k/Akt-PTEN, RAS/RAF/MEK, PARP) involved in GB tumorigenesis, pathophysiology, and treatment resistance acquisition. Below, we analyze several immunotherapeutic approaches (i.e., checkpoint inhibitors, vaccines, CAR-modified NK or T cells, oncolytic virotherapy) that have been used in an attempt to enhance the immune response against GB, and thereby avoid recidivism or increase survival of GB patients. Finally, we present treatment attempts made using nanotherapies (nanometric structures having active anti-GB agents such as antibodies, chemotherapeutic/anti-angiogenic drugs or sensitizers, radionuclides, and molecules that target GB cellular receptors or open the blood–brain barrier) and non-ionizing energies (laser interstitial thermal therapy, high/low intensity focused ultrasounds, photodynamic/sonodynamic therapies and electroporation). The aim of this review is to discuss the advances and limitations of the current therapies and to present novel approaches that are under development or following clinical trials.

show abstract

Section: Present Therapy and Challengesmentioning

confidence: 99%

Glioblastoma Therapy: Past, Present and Future

Obrador,

Moreno-Murciano,

Oriol-Caballo

et al. 2024

IJMS

View full text Add to dashboard Cite

show abstract

Is Carmustine Wafer Implantation in Progressive High-Grade Gliomas a Relevant Therapeutic Option? Complication Rate, Predictors of Complications and Onco-Functional Outcomes in a Series of 53 Cases

Gkasdaris,

Berthiller,

Guyotat

et al. 2024

Cancers

View full text Add to dashboard Cite

Background/Objectives: The aim was to determine the complication rate and the predictors of complications and survival in high-grade glioma surgically managed at progression with implantation of Carmustine wafers. Methods: A retrospective series of 53 consecutive patients operated on between 2017 and 2022 was built. Results: The median age was 55 ± 10.9 years. The rates of global and infectious complications were 35.8% and 18.9%, respectively. In multivariate analysis, patients with a preoperative neurological deficit were more prone to develop a postoperative complication (HR = 5.35 95% CI 1.49–19.26, p = 0.01). No predictor of infectious complication was identified. In the grade 4 glioma subgroup (n = 44), progression-free and overall survival (calculated starting from the reresection) reached 3.95 months, 95% CI 2.92–5.21 and 11.51 months, 95% CI 9.11–17.18, respectively. Preoperative KPS > 80% (HR = 0.97 95% CI 0.93–0.99, p = 0.04), Gross Total Resection (HR = 0.38 95% CI 0.18–0.80, p = 0.01), and 3-month postoperative KPS > 80% (HR = 0.35 95% CI 0.17–0.72, p = 0.004) were predictors of prolonged overall survival. Conclusions: Surgical resection is a relevant option in high-grade gliomas at progression, especially in patients with a preoperative KPS > 80%, without preoperative neurological deficit, and amenable to complete resection. In patients elected for surgery, Carmustine wafer implantation is associated with a high rate of complications. It is consequently critical to closely monitor the patients for whom this option is chosen.

show abstract

Towards Effective Treatment of Glioblastoma: The Role of Combination Therapies and the Potential of Phytotherapy and Micotherapy

Gaiaschi,

Bottone,

De Luca

2024

CIMB

View full text Add to dashboard Cite

Glioblastoma multiforme (GBM) is one of the most aggressive and difficult-to-treat brain tumors, with a poor prognosis due to its high resistance to conventional therapies. Current treatment options, including surgical resection, radiotherapy, and chemotherapy, have limited effectiveness in improving long-term survival. Despite the emergence of new therapies, monotherapy approaches have not shown significant improvements, highlighting the need for innovative therapeutic strategies. Combination therapies appear to be the most promising solution, as they target multiple molecular pathways involved in GBM progression. One area of growing interest is the incorporation of phytotherapy and micotherapy as complementary treatments, which offer potential benefits due to their anti-tumor, anti-inflammatory, and immunomodulatory properties. This review examines the current challenges in GBM treatment, discusses the potential of combination therapies, and highlights the promising role of phytotherapy and micotherapy as integrative therapeutic options for GBM management.

show abstract

Carmustine wafer implantation for supratentorial glioblastomas, IDH-wildtype in “extreme” neurosurgical conditions

Cited by 4 publications

References 53 publications

Glioblastoma Therapy: Past, Present and Future

Glioblastoma Therapy: Past, Present and Future

Is Carmustine Wafer Implantation in Progressive High-Grade Gliomas a Relevant Therapeutic Option? Complication Rate, Predictors of Complications and Onco-Functional Outcomes in a Series of 53 Cases

Towards Effective Treatment of Glioblastoma: The Role of Combination Therapies and the Potential of Phytotherapy and Micotherapy

Contact Info

Product

Resources

About