Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort
Year: 2015
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The standard of care for newly diagnosed glioblastoma is maximal safe surgical resection, followed by chemoradiation therapy. We assessed carmustine wafer implantation efficacy and safety when used in combination with standard care. METHODS: Included were adult patients with (n = 354, implantation group) and without (n = 433, standard group) carmustine wafer implantation during first surgical resection followed by chemoradiation standard protocol. Multivariate and case-matched analyses (controlled propensity-matched cohort, 262 pairs of patients) were conducted. RESULTS: The median progression-free survival was 12.0 months (95% CI: 10.7-12.6) in the implantation group and 10.0 months (9.0-10.0) in the standard group and the median overall survival was 20.4 months (19.0-22.7) and 18.0 months (17.0-19.0), respectively. Carmustine wafer implantation was independently associated with longer progression-free survival in patients with subtotal/total surgical resection in the whole series (adjusted hazard ratio [HR], 0.76 [95% CI: 0.63-0.92], P = .005) and after propensity matching (HR, 0.74 [95% CI: 0.60-0.92], P = .008), whereas no significant difference was found for overall survival (HR, 0.95 [0.80-1.13], P = .574; HR, 1.06 [0.87-1.29], P = .561, respectively). Surgical resection at progression whether alone or combined with carmustine wafer implantation was independently associated with longer overall survival in the whole series (HR, 0.58 [0.44-0.76], P < .0001; HR, 0.54 [0.41-0.70], P < .0001, respectively) and after propensity matching (HR, 0.56 [95% CI: 0.40-0.78], P < .0001; HR, 0.46 [95% CI: 0.33-0.64], P < .0001, respectively). The higher postoperative infection rate in the implantation group did not affect survival. CONCLUSIONS: Carmustine wafer implantation during surgical resection followed by the standard chemoradiation protocol for newly diagnosed glioblastoma in adults resulted in a significant progression-free survival benefit.
Source: Neuro-Oncology
Authors: Johan Pallud, Etienne Audureau, Georges Noel, Robert Corns, Emmanuèle Lechapt-Zalcman, Julien Duntze, Vladislav Pavlov, Jacques Guyotat, Phong Dam Hieu, Pierre-Jean Le Reste, Thierry Faillot, Claude-Fabien Litre, Nicolas Desse, Antoine Petit, Evelyne Emery, Jimmy Voirin, Johann Peltier, François Caire, Jean-Rodolphe Vignes, Jean-Luc Barat, Olivier Langlois, Edouard Dezamis, Eduardo Parraga, Marc Zanello, Edmond Nader, Michel Lefranc, Luc Bauchet, Bertrand Devaux, Philippe Menei, Philippe Metellus
Institutions: Centre National de la Recherche Scientifique, Institut Pasteur, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Institut Strauss, Paris-Est Sup, Pôle de recherche et d'enseignement supérieur Université Paris-Est, Université de Strasbourg, Leeds General Infirmary, Cyceron, Hôpital Maison Blanche, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Centre Hospitalier Universitaire de Rennes, Hôpital Beaujon, Hôpital d'Instruction des Armées Sainte-Anne, Centre Hospitalier Universitaire de Besançon, Centre Hospitalier Universitaire de Caen Normandie, Hopitaux Civils de Colmar, Centre Hospitalier Universitaire Amiens-Picardie, Centre Hospitalier Universitaire de Limoges, Hôpital Pellegrin, Hôpital privé Clairval, Centre Hospitalier Universitaire de Rouen, Centre Hospitalier Universitaire de Montpellier, Institute for Neurosciences of Montpellier, Hôpital Saint Eloi, Micro et Nanomédecines translationnelles, Aix-Marseille Université
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2225416751