Artikel
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
Suche in Medline nach
Autoren
Veröffentlicht: | 30. Mai 2008 |
---|
Gliederung
Text
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.