gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Treatment strategies for recurrent Glioblastoma multiforme: The impact of re-resection, Implantation of Carmustine wafers and intensified chemotherapy

Behandlungsstrategien des rezidivierenden Glioblastoms: Die Rolle der Re-Resektion, Implantation von Carmustine Wafern und intensivierter Chemotherapie

Meeting Abstract

  • corresponding author C. Ewelt - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf
  • J. Schroeteler - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf
  • J. Felsberg - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf
  • M. Sabel - Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.06.01

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Ewelt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Due to the primary treatment of patients with Glioblastoma multiforme (GBM) with alkylating drugs (AD) the role of a rechallenge with AD upon recurrence is subject to discussion. In addition the pivotal role of cytoreductive surgery for GBM, as demonstrated for the primary treatment, has not yet been evaluated for recurrent GBM. We therefore investigated the role of re-resection and intensified alkylating chemotherapy by both local and systemic regimens in a single institution series of patients with radiographic recurrence of GBM, stratified for MGMT status.

Methods: Since 12-2006 25 subsequent patients with recurrent GBM under Stupp regimen were included after informed consent was obtained. Patients were subject to re-resection, implantation of Carmustine wafers and were treated with Temozolomide one week on/ one week off (150 mg/m2/BS), 4 weeks after surgical treatment. Patients were evaluated pre- and postoperatively by Karnofsky- and the NIH-Score and serial MR-images (all parameters were collected presurgical, <72h after surgery and every 3 months). Toxicity was closely monitored every week. Overall survival (OS) and progression free survival (PFS; McDonald criteria) were determined after 3 months (PFS-3). The MGMT-promoter status was determined by methylation specific PCR.

Results: All patients had a near complete resection with less than 5ml residual tumor volume. Severe toxicity after WHO CTC was observed in 16 patients [Grade 3 (n=10) and 4 (n=6)]. All patients demonstrated a decreased Karnofsky - and NIH-Score immediately postoperatively, which stabilized until disease progression at a median of 70% and 7,0, respectively. As yet, the median PFS is 10,1 weeks, PFS-3 29% and median OS 20 months (first diagnosis to death). 72% of the patients were MGMT negative.

Conclusions: As yet, there are no data on the prognosis of patients with a recurrent GBM after Stupp. Therefore, the interpretation of our outcome data must be approached with caution. The high percentage of MGMT patients probably reflects a negative selection bias, due to the consecutive inclusion of recurrent patients in a single centre study. However, the OS demonstrated in our population compares favourable with the OS of the MGMT negative subpopulation published by Hegi (20/12.7 months). Though the toxicity of this regimen is acceptable, the clinical deterioration of the patients is not only attributable to the natural course of this disease.