• World Neurosurg · May 2023

    Newly-diagnosed high grade glioma surgery with carmustine wafers implantation. A long-term nationwide retrospective study.

    • Charles Champeaux-Depond, Vincent Jecko, Joconde Weller, Panayotis Constantinou, Philippe Tuppin, and Philippe Metellus.
    • Department of Neurosurgery, Hôpital privé Clairval - Ramsay Santé, Marseille, France. Electronic address: Charles.ChampeauxDepond@gmail.com.
    • World Neurosurg. 2023 May 1; 173: e778e786e778-e786.

    BackgroundWidespread use of carmustine wafers (CWs) to treat high-grade gliomas (HGG) has been limited by uncertainties about their efficacy. We sought to assess the outcome of patients after newly diagnosed HGG surgery with CW implantation and search for associated factors.MethodsWe processed the French medico-administrative national database between 2008 and 2019 to retrieve ad hoc cases. Survival methods were implemented.ResultsIn total, 1608 patients who had CW implantation after HGG resection at 42 different institutions between 2008 and 2019 were identified; 36.7% were female and, median age at HGG resection with CW implantation was 61.5 years, interquartile range (IQR) [52.9-69.1]. A total of 1460 patients (90.8%) had died at data collection at a median age at death of 63.5 years, IQR [55.3-71.2]. Median overall survival (OS) was 1.42 years, 95% confidence interval [CI] 1.35-1.49, i.e., 16.8 months. Median age at death was 63.5 years, IQR [55.3-71.2]. OS at 1, 2, and, 5 years was 67.4%, 95% CI 65.1-69.7; 33.1%, 95% CI 30.9-35.5; and 10.7%, 95% CI 9.2-12.4, respectively. In the adjusted regression, sex (hazard ratio [HR] 0.82, 95% CI 0.74-0.92, P < 0.001), age at HGG surgery with CW implantation (HR 1.02, 95% CI 1.02-1.03, P < 0.001), adjuvant radiotherapy (HR 0.78, 95% CI 0.7-0.86, P < 0.001), chemotherapy by temozolomide (HR 0.7, 95% CI 0.63-0.79, P < 0.001), and redo surgery for HGG recurrence (HR 0.81, 95% CI 0.69-0.94, P = 0.005) remained significantly associated with the outcome.ConclusionsOS of patients with newly diagnosed HGG who underwent surgery with CW implantation is better in young patients, those of the female sex, and for those who complete concomitant chemoradiotherapy. Redo surgery for HGG recurrence also was associated with prolonged survival.Copyright © 2023 Elsevier Inc. All rights reserved.

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