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

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Abstract

We assessed the feasibility of Carmustine wafer implantation in “extreme” conditions (i.e. patients > 80 years and Karnofsky Performance Status score < 50) and of implantation ≥ 12 Carmustine wafers in adult patients harbouring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. We performed an observational, retrospective single-centre cohort study at a tertiary surgical neuro-oncological centre between January 2006 and December 2021. Four hundred eighty patients who benefited from a surgical resection at first-line treatment were included. We showed that Carmustine wafer implantation in patients > 80 years, in patients with a Karnofsky performance status score < 50, and that implantation ≥ 12 Carmustine wafers (1) did not increase overall postoperative complication rates, (2) did not affect the completion of standard radiochemotherapy protocol, (3) did not worsen the postoperative Karnofsky Performance Status scores, and (4) did not significantly affect the time to oncological treatment. We showed that the implantation of ≥ 12 Carmustine wafers improved progression-free survival (31.0 versus 10.0 months, p = 0.025) and overall survival (39.0 versus 16.5 months, p = 0.041) without increasing postoperative complication rates. Carmustine wafer implantation during the surgical resection of a newly diagnosed supratentorial glioblastoma, IDH-wildtype is safe and efficient in patients > 80 years and in patients with preoperative Karnofsky Performance Status score < 50. The number of Carmustine wafers should be adapted (up to 16 in our experience) to the resection cavity to improve survival without increasing postoperative overall complication rates.

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Acknowledgements

Alexandre Roux would like to thank the Nuovo-Soldati Foundation for Cancer Research for their support.

Author information

Author notes

  1. Marc Zanello and Johan Pallud contributed equally to this work.

Authors and Affiliations

  1. Service de Neurochirurgie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte Anne, 75014, Paris, France

    Alexandre Roux, Oumaima Aboubakr, Angela Elia, Alessandro Moiraghi, Chiara Benevello, Houssem Fathallah, Eduardo Parraga, Edouard Dezamis, Marc Zanello & Johan Pallud

  2. Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, 75014, Paris, France

    Alexandre Roux, Oumaima Aboubakr, Angela Elia, Alessandro Moiraghi, Catherine Oppenheim, Fabrice Chretien, Marc Zanello & Johan Pallud

  3. Service de Neuroradiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte Anne, 75014, Paris, France

    Catherine Oppenheim

  4. Service de Neuropathologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte Anne, 75014, Paris, France

    Fabrice Chretien

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Contributions

Alexandre ROUX: conception and design of the study, acquisition and analysis of data, drafting a significant portion of the manuscript or figures.

Oumaima ABOUBAKR: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Angela ELIA: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Alessandro MOIRAGHI: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Houssem FATHALLAH: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Chiara BENEVELLO: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Eduardo PARRAGA: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Catherine OPPENHEIM: drafting a significant portion of the manuscript or figures

Fabrice CHRETIEN: drafting a significant portion of the manuscript or figures

Edouard DEZAMIS: acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Marc ZANELLO: conception and design of the study, drafting a significant portion of the manuscript or figures

Johan PALLUD, conception and design of the study, acquisition and analysis of data, drafting a significant portion of the manuscript or figures

Corresponding author

Correspondence to Alexandre Roux.

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Ethics approval

The study received required authorizations (IRB#12022/47) from the human research institutional review board (IRB00011687).

Consent to participate

The requirement to obtain informed consent was waived according to French legislation.

Competing interests

Johan PALLUD and Alexandre ROUX have received honoraria for consultancy from Kyowa Hakko Kirin Co. Johan PALLUD and Alexandre ROUX have received honoraria for speaking engagements (including travel and accommodation) from Kyowa Hakko Kirin Co.

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Roux, A., Aboubakr, O., Elia, A. et al. Carmustine wafer implantation for supratentorial glioblastomas, IDH-wildtype in “extreme” neurosurgical conditions. Neurosurg Rev 46, 140 (2023). https://doi.org/10.1007/s10143-023-02052-x

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