Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: a 10-year institutional experience.

Abstract

BACKGROUND:

Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly used for local delivery of BCNU to high-grade gliomas after resection and is associated with increased survival. Various complications of Gliadel wafers have been reported but not consistently reproduced. We set out to characterize Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for treatment of malignant glioma.

METHODS:

We retrospectively reviewed records of 1013 patients undergoing craniotomy for resection of malignant brain astrocytoma (World Health Organization grade III/IV disease). Perioperative morbidity occurring within 3 months of surgery was assessed for patients and compared between patients receiving versus not receiving Gliadel wafer. Overall survival was assessed for all patients.

RESULTS:

A total of 1013 craniotomies were performed for malignant brain astrocytoma. A total of 288 (28%) received Gliadel wafer (250 glioblastoma multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma (AA/AO), 166 primary resection, 122 revision resection). Compared with the non-Gliadel cohort, patients receiving Gliadel were older (55 +/- 14 vs. 50 +/- 17, P = .001) and more frequently underwent gross total resection (75% vs 36%, P < .01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had similar incidences of perioperative surgical site infection (2.8% vs. 1.8%, P = .33), cerebrospinal fluid leak (2.8% vs. 1.8%, P = .33), meninigitis (.3% vs. .3%, P = 1.00), incisional wound healing difficulty (.7% vs. .4%, P = .63), symptomatic malignant edema (2.1% vs. 2.3%, P = 1.00), 3-month seizure incidence (14.6% vs. 15.7%, P = .65), deep-vein thrombosis (6.3% vs. 5.2%, P = .53), and pulmonary embolism (PE) (4.9% vs. 3.7%, P = .41). For patients receiving Gliadel for GBM, median survival was 13.5 months after primary resection (20% alive at 2 years) and 11.3 months after revision resection (13% alive at 2 years). For patients receiving Gliadel for AA/AO, median survival was 57 months after primary resection (66% alive at 2 years) and 23.6 months after revision resection (47% alive at 2 years).

CONCLUSION:

In our experience, use of Gliadel wafer was not associated with an increase in perioperative morbidity after surgical treatment of malignant astrocytoma.

• Authors: Frank J Attenello, Debraj Mukherjee, Ghazala Datoo, Matthew J McGirt, Eileen Bohan, Jon D Weingart, Alessandro Olivi, Alfredo Quinones-Hinojosa, Henry Brem
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 15 Issue 10 Pg. 2887-93 (Oct 2008) ISSN: 1534-4681 [Electronic] United States
• PMID: 18636295 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antineoplastic Agents, Alkylating
• Biocompatible Materials
• Decanoic Acids
• Drug Carriers
• Polyesters
• decanedioic acid-4,4'-(1,3-propanediylbis(oxy))bis(benzoic acid) copolymer
• Carmustine

Topics

• Antineoplastic Agents, Alkylating (therapeutic use)
• Biocompatible Materials (therapeutic use)
• Brain Neoplasms (drug therapy, pathology, surgery)
• Carmustine (therapeutic use)
• Combined Modality Therapy
• Decanoic Acids (therapeutic use)
• Drug Carriers
• Female
• Glioblastoma (drug therapy, pathology, surgery)
• Humans
• Magnetic Resonance Spectroscopy
• Male
• Middle Aged
• Neurosurgical Procedures
• Polyesters (therapeutic use)
• Prognosis
• Retrospective Studies
• Survival Rate
• Treatment Outcome