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

First line treatment of malignant glioma with carmustine implants followed by concomitant radio-chemotherapy: a multicentre experience in 29 patients

Konkomitante Radiochemotherapie nach Gliadelimplantation: Multizentrische Erfahrungen bei 29 Patienten

Meeting Abstract

  • corresponding author H.C. Bock - Abteilung Neurochirurgie, Universitätsmedizin Göttingen
  • M. J. A. Puchner - Abteilung Neurochirurgie, Bundesknappschaftskrankenhaus Recklinghausen
  • F. Lohmann - Abteilung Neurochirurgie, Bundesknappschaftskrankenhaus Recklinghausen
  • M. Schütze - Abteilung Neurochirurgie, Chirurgische Klinik und Poliklinik, Universität Rostock
  • R. Buchalla - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg
  • A. Giese - Abteilung Neurochirurgie, Universitätsmedizin Göttingen

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.06.02

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

Published: May 30, 2008

© 2008 Bock 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: Randomized trials showed significant improvement of survival after implantation of Carmustine wafers for patients with newly diagnosed malignant glioma. The introduction of concomitant radio-TMZ chemotherapy has further demonstrated a survival benefit for glioma patients. Lately, this has resulted in clinical protocols combining these treatment regiments. However, this carries the risk of increased toxicity. We have compiled the treatment experience of four centres using implantation of Carmustine wafers at primary surgery followed by radiation therapy and 75mg/m2/d TMZ performed under clinical protocols.

Methods: We have retrospectively analyzed the postoperative clinical course, adverse events, progression free interval, and survival in 29 patients with newly diagnosed GBM who received Gliadel therapy followed by radiation-chemotherapy.

Results: Of 29 patients (age 59±12.9) with glioblastoma who received Gliadel wafer at primary surgery 48% had progressed at time of data analysis. In patients who progressed the mean progression free interval by MRI was 5,2±4,0 months and overall survival in patients who had died was 6,8±4,4 months. 15 patients remained progression free with a mean follow-up of 8,2±4,5 months. Serious adverse events occurred in 17 % of patients. Adverse events included wound healing abnormalities (21 %), abscess (10%), csf-fistulas (10%), nuchal rigidity and pleocytosis (10%), newly diagnosed seizures (3%), delayed brain edema (17%), thrombosis with pulmonary embolism (7%), or hydrocephalus (3%).

Conclusions: Because of a proven benefit of both local chemotherapy with Gliadel and the well established radiation and systemic TMZ chemotherapy combination of both is attractive and may utilize the sensitizing effect of TMZ and Carmustine on MGMT and AGT resistance genes. Our data demonstrate that combination of local chemotherapy and concomitant radiation-chemotherapy is promising, but carries a significant risk of additional toxicity compared to data published for both treatment modalities alone. Further studies will have to determine whether specific surgical techniques and adapted follow-up schedules can minimize the risk of toxicity.