gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Recurrence patterns after local therapy with Gliadel® in patients with malignant gliomas

Meeting Abstract

  • L. Dörner - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • A. Mustafa - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • A. Rohr - Institut für Neuroradiologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • A. Nabavi - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • H.M. Mehdorn - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.10-03

DOI: 10.3205/09dgnc242, URN: urn:nbn:de:0183-09dgnc2422

Published: May 20, 2009

© 2009 Dörner et al.
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Outline

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Objective: Local chemotherapy with gliadel® has been increasingly used in the last years. A study by Giese et al. with 11 patients receiving the actual BCNU wafers had shown no difference of recurrence patterns in local and systemic chemotherapy. It also made no difference in total or subtotallyresected gliomas. Our goal was to verify the results in a larger patient group and to look at the rationale for the use of Gliadel® in the presence of residual tumor.

Methods: In the cohort of patients operated from 2006 to 2008 with malignant glioma that received Gliadel® wafers, we carried out a retrospective and a prospective analysis of the pattern of recurrence. 60 patients were included in the study. 36 had been totally resected and 20 sub totally.

30 patients had a tumor recurrence documented on MRI so far. The recurrent tumor was divided into 4 groups: local recurrence (≤1.5 cm of the resection cavity), diffuse (>1.5 cm), multifocal and distant tumors. Patients were divided into groups of total resection and subtotal resection. 50% of the patients received concomitant therapy with temozolamide. 30% had been pretreated with temozolamide. The average tumor volume before treatment was 28.4 cm3.

Results: In our study group, on the average 50% of the tumors reoccurred 6 months following Gliadel® placement. 11 (7 of the totally resected tumors) tumors recurred locally, 13 (6) diffuse, 5 (2) multifocal and 1 (1) distant.

Conclusions: There were no differences in the recurrence pattern of malignant glioma patients treated locally with Gliadel® compared to patients receiving systemic chemotherapy. In a similar fashion, we found no difference in the recurrence pattern of completely or incompletely resected tumors. This corresponds to the hypothesis that the local effect of Gliadel® wears off after the BCNU has been released. A concomitant continuing therapy with another chemotherapeutic agent (temozolamide) is necessary to prolong the state of remission. The combined effect is of the same potential in complete and incompletely resected tumors but will not prevent the local reoccurrence of the tumor.

But as recent studies show, the concomitant use of temzolamide and Gliadel® significantly improves survival in comparison to monotherapy.