Annals of Surgical Oncology

, Volume 17, Issue 7, pp 1740-1746

First online:

Biodegradable Carmustine Wafers (Gliadel) Alone or in Combination with Chemoradiotherapy: The French Experience

  • Philippe MeneiAffiliated withDépartement de Neurochirurgie, INSERM U646, CHU d’Angers Email author 
  • , Philippe MetellusAffiliated withService de Neurochirurgie, Hôpital de la Timone
  • , Elsa Parot-SchinkelAffiliated withCentre de Recherche Clinique, CHU d’Angers
  • , Hugues LoiseauAffiliated withClinique Universitaire de Neurochirurgie, Hôpital Pellegrin Tripode
  • , Laurent CapelleAffiliated withService de Neurochirurgie, Hôpital Pitié Salpétrière
  • , Guy JacquetAffiliated withService de Neurochirurgie, Hôpital Jean Minjoz
  • , Jacques GuyotatAffiliated withService de Neurochirurgie, Hôpital Neurologique Pierre Wertheimer
  • , The Neuro-oncology Club of the French Society of Neurosurgery

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Carmustine-releasing wafers (Gliadel®) have been available and reimbursed in France since 2005.


A retrospective multicenter study was conducted in 26 French Departments of Neurosurgery to analyze practices of French neurosurgeons using Gliadel, compare the adverse effects and survival with those of previous phase III trials, and assess survival in patients with newly diagnosed malignant gliomas (MG) receiving Gliadel plus radiochemotherapy with temozolomide (TMZ). A total of 163 patients who received Gliadel for MG were included in this study: 83 (51%) with newly diagnosed MG and 80 (49%) with recurrent MG. In the newly diagnosed group, 51.8% of patients received radiochemotherapy with TMZ.


Adverse events (AEs) emerged in 44.6% of the population, including 6% with septic abscess. The AE rate was not statistically correlated with adjuvant use of TMZ. For the newly diagnosed group, median survival was 17 months. Total or subtotal resection appeared to have a great impact on survival (P = 0.016), as did treatment with adjuvant radiotherapy (P = 0.004).

For the group with recurrent MG, median survival was 7 months. Total or subtotal resection excision appeared to have a great impact on survival (P = 0.002), as did preoperative Karnowsky Scale (PO-KPS) (P = 0.012).


Survival rates for newly diagnosed patients were better than those reported in previous phase III trials. The combination of Gliadel and radiochemotherapy with TMZ was well tolerated and appeared to increase survival without increasing AEs.