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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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The impact of carmustine implantation A retrospective monocentric analysis for recurrent high grade glioma patients

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  • Sabrina Köber - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Marcel Alexander Kamp - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Michael Sabel - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Marion Rapp - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP062

doi: 10.3205/18dgnc403, urn:nbn:de:0183-18dgnc4037

Published: June 18, 2018

© 2018 Köber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Carmustine wafers are approved for the treatment of primary and recurrent HGG. This monocentric analysis examined potential prognostic factors on OS and PFS after recurrent tumor surgery with carmustine implantation.

Methods: In a retrospective study design we analyzed PFS, OS after resection for recurrent HGG in correlation with potential predictors as tumor diagnosis, KPS pre/post, extent of resection, age, MGMT methylation status, IDH-1 mutation and further adjuvant therapy.

Results: Between 2010 and 2017 214 patients received intraoperative implantation of carmustine wafer at our neurooncological department. Neuropathological diagnoses were: 153 (70,5%) patients with prim GBM, 25 patients (11.5%) sec GBM, 27 patients (11.5%) A III, 7 patients (3.2%) OA III.

Carmustine wafers were implanted in 53% (n=123) after first recurrence, after second recurrence in 23% (n=56) and third recurrence in 8.3% (n=8,2). As further adjuvant therapy 68 patients (47%) received intensified TMZ, 37 patients (26%) re-radiation, 14 other chemotherapy (Avastin, PC, 9.7%). 26 patients received no further therapy (17.9%). Median OS after carmustine implantation was 8.1 m (CI 6.7-9.4), median PFS 4.7 m after first recurrence (CI 4.0-5.4).

There was no significant impact on OS after carmustine implantation for: MGMT methylation status (p=0.45), extent of resection (p=0.15), KPS pre-OP (p= 0.59) and post- OP (p=0.24). A significant impact on survival was observed for IDH1 mutation status (p=0.03), further adjuvant therapy (p=0.012), age (p=0.013) and amount of resections with carmustine implantation (p=0.017). MGMT methylation status (p=0.014) was significant for PFS.

Postoperative infections after first recurrence were observed in 16 patients (in 3 patients after second time carmustine implantation).

The subgroup analysis identified younger patients (20-34 years) with positive IDH-1 mutation status and postoperative re-radiation with the highest mOS after recurrence (13.4 m (CI 10.3-16.5)).

Conclusion: Following carmustine implantation we could identify further adjuvant therapy and IDH-1 mutation status as important impact factors correlating with an increased OS. Especially younger patients with positive IDH-1 mutation status and re-radiation seemed to benefit from additional carmustine implantation.