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

Safety and feasibility of the adjunct of local chemiotherapy with biodegradable carmustine (BCNU) wafers to the standard multimodal approach to newly diagnosed high grade gliomas

Meeting Abstract

  • corresponding author M. Salvati - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • C. Brogna - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • A. D’Elia - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • A. G. Melone - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • A. Santoro - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • M. Antonelli - Sperimental Medicine Department, II University of Rome, Ospedale Sant’Andrea, Rome, Italy
  • F. Giangaspero - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy
  • R. Delfini - Neuroscience-Neurosurgery department, “Sapienza” University, Rome, Italy

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. DocP 013

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

Published: May 30, 2008

© 2008 Salvati 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: To determine the safety and feasibility of the combined treatment with surgery and intraoperative placement of carmustina 7,7 mg wafers (Gliadel®), followed by standard adjuvant treatment with radiotherapy and concomitant and subsequent chemiotherapy with temozolomide (TMZ) for supratentorial high grade gliomas at first diagnosis.

Methods: In the period between february 2006 and july 2007, 24 patients, ageing from 35 to 72 years (median age: 59,1 years), were treated at our institution for newly diagnosed cerebral supratentorial high grade glioma. Treatment consisted in surgery and intraoperative placement of wafers of carmustine at (Gliadel®), followed by combined radio- and chemiotherapy, according to standard international protocols. The diagnosis of high grade glioma was made first intraoperatively in an estemporary fashion. The number of the wafers that were implanted varied from 5 to 10 with a median of 7,2 wafers. TC examination was performed after demission in every cases.

Results: No hematoma was observed in any case. Except a mild fever lasting 2 days after surgery in one case, not other postsurgical complications could be observed. After a median time of 4,8 weeks (range: 3-6 weeks) all patients began adjuvant treatment with concomitant radiotherapy with a mean of 60 Gy delivered in 30 fractions and TMZ 75 mg/m2, administered one hour before every radiotherapy fraction, followed after 3 to 6 weeks by adjuvant TMZ 5 days every 28, 200 mg/m2 for not less than 12 cycles. MRI with Gd were routinely performed. During concomitant radio- and chemiotherapy weekly hematologic assessment were routinely performed: no significant alterations were observed. The mean presurgical KPS was of 80 (range: 60-100), and it remained unmodified after surgery and adjuvant treatment. Follow-up after surgery ranged from 4 to 17 months: in 4 cases there was a radiologic evidence of progressive disease, with a progression-free survival of 6, 8, 9,5 and 13,6 months. One case died 14 months after first operation. All other patients are still alive.

Conclusions: The integration of local chemiotherapy with carmustine wafers and the standard adjuvant regimen appears to be safe and feasible, without any adjunctive complication.