Biodegradable Carmustine Wafers (Gliadel) Alone or in Combination with Chemoradiotherapy: The French Experience
- 272 Downloads
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.
We would like to thank the neurosurgeons, radiotherapists, oncologists, radiologists, and nurses who participated to this study and provided patient care. We thank also belongs to the authors Karim P. Moubarak MD for editorial assistance. Special thanks to: P Toussaint (Amiens); GA Czorny, J Godard, H Katranji (Besançon); T Faillot, M Kalamarides, G Iakolev (Beaujon-Paris); T Riem, A Rougier, P Monteil, G Penchet, JR Vigne, D Loguoro (Bordeaux); E Emery, JM Derlon, R Gadan, E. Lechapt-Zalcman (Caen); R Giacomelli, A. Monjour, B. Stilhart (Colmar); D Hoffmann (Grenoble); A Desplat (Pau), X Morandi, A Hamlat, L Riffaud, G Brassier (Rennes); O Langlois, F. Proust (Rouen); R Duthel (St Etienne); P François (Tours); M Gigaud, M Tremoulet (Toulouse); L Bauchet (Montpellier); C Pinelli (Nancy); K Moubarak, P Decq, and JP NGuyen (Paris-Henri Mondor).
- 8.LaRocca RV, et al. A phase 2 study of radiation with concomitant and then sequential temozolomide (TMZ) in patients with newly diagnosed supratentorial high-grade malignant glioma who have undergone surgery with carmustine (BCNU) wafer insertion [abstract]. Neuro Oncol. 2006;8(4):445.Google Scholar
- 11.Rich JN, et al. Overall survival of primary glioblastoma (GBM) patients receiving carmustine (BCNU) wafers followed by radiation (RT) and concurrent temozolomide (TMZ) plus rotational multi-agent chemotherapy [abstract]. J Clin Oncol. 2007;25:2070.Google Scholar