Evaluation of post-operative complications associated with repeat resection and BCNU wafer implantation in recurrent glioblastoma

Zella, Maria Angela Samis; Wallocha, Marta; Slotty, Philipp J.; Isik, Gueler; Hänggi, Daniel; Schroeteler, Juliane; Ewelt, Christian; Steiger, Hans‐Jakob; Sabel, Michael

doi:10.1007/s00701-013-1931-6

Cited by 21 publications

(8 citation statements)

References 40 publications

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“… 43 Two articles 44 , 45 used the same experimental data from the study by Westphal et al 6 One study did not present the survival data and we could not contact the author using the email provided in his article. 46 The study focusing on recurrent GBM was also excluded. 47 Finally, seven studies were included in our research.…”

Section: Resultsmentioning

confidence: 99%

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

Xing¹,

Shao²,

Qi³

et al. 2015

DDDT

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BackgroundStandard treatment for high-grade glioma (HGG) includes surgery followed by radiotherapy and/or chemotherapy. Insertion of carmustine wafers into the resection cavity as a treatment for malignant glioma is currently a controversial topic among neurosurgeons. Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).MethodWe searched the PubMed and Web of Science databases without any restrictions on language using the keywords “Gliadel wafers”, “carmustine wafers”, “BCNU wafers”, or “interstitial chemotherapy” in newly diagnosed GBM for the period from January 1990 to March 2015. Randomized controlled trials (RCTs) and cohort studies/clinical trials that compared treatments designed with and without carmustine wafers and which reported overall survival or hazard ratio (HR) or survival curves were included in this study. Moreover, the statistical analysis was conducted by the STATA 12.0 software.ResultsSix studies including two RCTs and four cohort studies, enrolling a total of 513 patients (223 with and 290 without carmustine wafers), matched the selection criteria. Carmustine wafers showed a strong advantage when pooling all the included studies (HR =0.63, 95% confidence interval (CI) =0.49–0.81; P=0.019). However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR =0.51, 95% CI =0.18–1.41; P=0.426), while the cohort studies demonstrated a significant survival increase (HR =0.59, 95% CI =0.44–0.79; P<0.0001).ConclusionCarmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM. More studies should be designed for newly diagnosed GBM in the future.

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Section: Resultsmentioning

confidence: 99%

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

Xing¹,

Shao²,

Qi³

et al. 2015

DDDT

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“…One study did not report OS or median survival and was also excluded. 36 All patients had high-grade III or IV glioma. Of the 6 trials, 4 (75%) demonstrated a significant (p ≤ 0.05) percent increase in median survival as compared to control, or non-disruptive treatment (Figure 1).…”

Section: Overall Efficacymentioning

confidence: 98%

“…In the most recently published study on wafer implant therapy, Samis-Zella et al 36 compared the use of implantable wafers for recurrent grade IV GBM with patients with similar glioma who did not get wafer treatment. All patients were given TMZ as well as prophylactic cefazolin and dexamethasone post-surgically.…”

Section: Summary Of Drug Wafer Therapy Studiesmentioning

confidence: 99%

Bypassing the Blood-Brain Barrier to Treat Brain Cancer: A Systematic Review of the Efficacy of Carmustine Wafer Implant Therapy

Sharobim¹

2021

MSRJ

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Introduction: Gliomas are neoplasms of the central nervous system (CNS). Despite aggressive treatment, median survival of malignant tumors remains poor at 12 - 18 months. Newer treatments allow delivery of therapeutic substances across the selectively permeable blood-brain barrier (BBB). This allows for chemotherapeutics to more easily reach their target location in the CNS. Drug eluting wafers made up of carmustine can be placed in the surgical resection cavity of a tumor and clinical trials to date have demonstrated their utility. Hypothesis: Bypassing the BBB to allow greater accumulation of chemotherapeutics in the CNS will improve clinical outcomes in glioma patients. Methods: Studies from medical literature databases describing trials using carmustine wafers implanted after glioma resection were obtained. To test our hypothesis, the available data using this therapy was compared to current first line treatment data for glioma as described by Stupp and colleagues. The inclusion criterion for efficacy analysis was histopathologically confirmed primary glioma. Exclusion criteria included presence of metastasis or pediatric tumors. Results: 10 studies describing wafer therapy use were initially gathered, encompassing over 500 patients. 6 studies met criteria for treatment efficacy analysis. 4 of 6 (75%) trials exhibited significant survival advantage as compared to control treatment. Furthermore, 3 of the 4 (75%) studies showing significance also demonstrated equal or higher percent increase in overall survival from control as compared to data generated from current first line therapy. Conclusion: Treatments bypassing the BBB are not currently standard-of-care for patients with glioma. We uncovered that most trials using carmustine implants post tumor resection describe increased overall survival, however in specific cohorts. Diverting the BBB in general may also have fewer side effects in contrast to classical routes of therapy. Future work is needed to develop similar therapeutics that improve outcomes in all age, gender, and prognostic risk factor populations.

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“…Gliadel wafers, a carmustine-imbedded polyanhydride copolymer matrix implant, have perhaps been the most successful localized therapy and are FDA approved for newly diagnosed and recurrent glioblastoma, modestly extending overall survival of both groups 14 . Wafer implantation has drawbacks, however, with increased risk of complications such as surgical site breakdown, infection, cerebrospinal fluid leak, brain edema, hydrocephalus, and cyst formation reported in some studies 15 , though not all 16,17 . Nonetheless, tumor recurrence is common even after carmustine wafer use, with median survival times of 16.4 and 9.7 months for newly diagnosed and recurrent GBM, respectively.…”

mentioning

confidence: 99%

Commentary: Current status of intratumoral therapy for glioblastoma

Mehta¹

2016

J Neurol Neuromedicine

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Evaluation of post-operative complications associated with repeat resection and BCNU wafer implantation in recurrent glioblastoma

Abstract: The use of the Stupp protocol as frontline therapy in patients with glioblastoma does not preclude the use of BCNU wafers at the time of progression.

Cited by 21 publications

References 40 publications

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

Bypassing the Blood-Brain Barrier to Treat Brain Cancer: A Systematic Review of the Efficacy of Carmustine Wafer Implant Therapy

Commentary: Current status of intratumoral therapy for glioblastoma

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Evaluation of post-operative complications associated with repeat resection and BCNU wafer implantation in recurrent glioblastoma

Abstract: The use of the Stupp protocol as frontline therapy in patients with glioblastoma does not preclude the use of BCNU wafers at the time of progression.

Cited by 21 publications

References 40 publications

The role of Gliadel wafers in the treatment of&nbsp;newly diagnosed GBM: a meta-analysis

The role of Gliadel wafers in the treatment of&nbsp;newly diagnosed GBM: a meta-analysis

Bypassing the Blood-Brain Barrier to Treat Brain Cancer: A Systematic Review of the Efficacy of Carmustine Wafer Implant Therapy

Commentary: Current status of intratumoral therapy for glioblastoma

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The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis