Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort

被引：58

作者：

Pallud, Johan ^{[1
,2
,3
]}

Audureau, Etienne ^{[4
,5
]}

Noel, Georges ^{[6
,7
]}

Corns, Robert ^{[8
]}

Lechapt-Zalcman, Emmanuele ^{[9
,10
,11
,12
]}

Duntze, Julien ^{[13
]}

Pavlov, Vladislav ^{[1
,2
]}

Guyotat, Jacques ^{[14
]}

Hieu, Phong Dam ^{[15
]}

Le Reste, Pierre-Jean ^{[16
]}

Faillot, Thierry ^{[17
]}

Litre, Claude-Fabien ^{[13
]}

Desse, Nicolas ^{[18
]}

Petit, Antoine

Emery, Evelyne

Voirin, Jimmy ^{[19
,20
]}

Peltier, Johann ^{[21
]}

Caire, Francois ^{[22
]}

Vignes, Jean-Rodolphe ^{[23
]}

Barat, Jean-Luc ^{[24
]}

Langlois, Olivier ^{[25
]}

Dezamis, Edouard ^{[1
,2
]}

Parraga, Eduardo ^{[2
]}

Zanello, Marc ^{[1
,2
]}

Nader, Edmond ^{[26
]}

Lefranc, Michel ^{[21
]}

Bauchet, Luc ^{[27
]}

Devaux, Bertrand ^{[1
,2
]}

Menei, Philippe ^{[24
,26
,28
]}

Metellus, Philippe

机构：

[1] Hop St Anne, Serv Neurochirurg, 1 Rue Cabanis, F-75674 Paris 14, France

[2] Paris Descartes Univ, Paris, France

[3] Inst Pasteur, Dept Histopathol & Anim Models, Paris, France

[4] Henri Mondor Teaching Hosp, Dept Publ Hlth, Creteil, France

[5] Univ Paris Est Creteil, Lab Invest Clin, Creteil, France

[6] Ctr Lutte Canc Paul Strauss, Dept Radiotherapy, Strasbourg, France

[7] Strasbourg Univ, Radiobiol Lab, Federat Translationnal Med Strasbourg FMTS, Strasbourg, France

[8] Leeds Gen Infirm, Dept Neurosurg, Leeds, W Yorkshire, England

[9] Caen Univ Hosp, Dept Pathol, Caen, France

[10] CNRS, UMR 6232, CERVOxy Grp, Caen, France

[11] Univ Caen Basse Normandie, UMR 6232, CERVOxy Grp, Caen, France

[12] CEA, UMR 6232, CERVOxy Grp, Caen, France

[13] Reims Univ Hosp, Maison Blanche Hosp, Dept Neurosurg, Reims, France

[14] Pierre Wertheimer Neurol & Neurosurg Hosp, Lyon Civil Hosp, Serv Neurosurg D, Lyon, France

[15] Univ Brest, Univ Med Ctr, Fac Med, Dept Neurosurg, Brest, France

[16] Univ Hosp Pontchaillou, Dept Neurosurg, Rennes, France

[17] Beaujon Hosp, AP HP, Dept Neurosurg, Clichy, France

[18] Sainte Anne Mil Teaching Hosp, Dept Neurosurg, Toulon, France

[19] Pasteur Hosp, Dept Neurosurg, Colmar, France

[20] Hautepierre Hosp, Dept Neurosurg, Strasbourg, France

[21] Amiens Univ Hosp, Dept Neurosurg, Amiens, France

[22] CHU Limoges, Serv Neurochirurg, Limoges, France

[23] CHU Pellegrin, Serv Neurochirurg A, Bordeaux, France

[24] Clairval Private Hosp, Dept Neurosurg, Marseille, France

[25] Rouen Univ Hosp, Dept Neurosurg, Rouen, France

[26] CHU Angers, Dept Neurosurg, Angers, France

[27] Gui de Chauliac Hosp, Dept Neurosurg, Montpellier, France

[28] Aix Marseille Univ, UMR911, CRO2, Marseille, France

来源：

NEURO-ONCOLOGY | 2015年 / 17卷 / 12期

关键词：

carmustine wafers; chemoradiotherapy; glioblastoma; surgery; survival; GLIOMAS RESPONSE ASSESSMENT; HIGH-GRADE GLIOMAS; MALIGNANT GLIOMA; ADJUVANT TEMOZOLOMIDE; PHASE-III; CONCURRENT TEMOZOLOMIDE; GLIADEL WAFERS; BCNU WAFERS; RADIOTHERAPY; CONCOMITANT;

D O I：

10.1093/neuonc/nov126

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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.

引用

页码：1609 / 1619

页数：11

共 32 条

[1] Overall Survival of Newly Diagnosed Glioblastoma Patients Receiving Carmustine Wafers Followed by Radiation and Concurrent Temozolomide Plus Rotational Multiagent Chemotherapy [J].