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

  • Clinical Article - Brain Tumors
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Abstract

Background

Patients with glioblastoma treated with BCNU wafer implantation for recurrence frequently receive frontline chemoradiotherapy with temozolomide as part of the Stupp protocol. A retrospective investigation was conducted of surgical complications in a cohort of these patients treated at a single institution.

Methods

We searched our institutional database for patients treated between January 2006 and October 2012 who had recurrent glioblastoma previously treated with open surgery followed by the Stupp protocol and then underwent repeat resection with or without BCNU wafers for recurrent disease. Rates of select post-operative complications within 3 months of surgery were estimated.

Results

We identified 95 patients with glioblastoma who underwent resection followed by the Stupp protocol as frontline treatment. At disease recurrence (first and second recurrence), 63 patients underwent repeat resection with BCNU wafer implantation and 32 without implantation. Generally, BCNU wafer use was associated with minor to moderate increases in rates of select complications versus non-implantation—wound healing abnormalities (14.2 vs. 6.2 %), cerebrospinal fluid leak (7.9 vs. 3.1 %), hydrocephalus requiring ventriculoperitoneal shunt (6.3 vs. 9.3 %), chemical meningitis (3.1 vs. 0 %), cerebral infections (3.1 vs. 0 %), cyst formation (3.1 vs. 3.1 %), cerebral edema (4.7 vs. 0 %), and empyema formations (1.5 vs. 0 %). Performance status was well maintained post-operatively in both groups. Median progression-free survival from the time of first recurrence was 6.0 and 5.0 months, respectively.

Conclusions

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.

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Acknowledgments

Writing and editorial assistance was provided by Michael Raffin (Fishawack Communications), and was financially supported by Archimedes Pharma.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Heinrich Heine University Hospital Düsseldorf, Medical Faculty, Moorenstraße 5, 40225, Düsseldorf, Germany

    Maria Angela Samis Zella, Marta Wallocha, Philipp J. Slotty, Daniel Hänggi, Hans-Jakob Steiger & Michael Sabel

  2. Department of Neurosurgery, University Hospital, Munster, Germany

    Juliane Schroeteler & Christian Ewelt

  3. Neurosurgery HELIOS Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany

    Gueler Isik

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  1. Maria Angela Samis Zella
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Correspondence to Maria Angela Samis Zella.

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Samis Zella, M.A., Wallocha, M., Slotty, P.J. et al. Evaluation of post-operative complications associated with repeat resection and BCNU wafer implantation in recurrent glioblastoma. Acta Neurochir 156, 313–323 (2014). https://doi.org/10.1007/s00701-013-1931-6

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  • DOI: https://doi.org/10.1007/s00701-013-1931-6

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