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Morbidity
and survival after 1,3-bis(2-chloroethyl)-1-nitrosourea wafer implantation for
recurrent glioblastoma: a retrospective case-matched cohort series
Subach
BR, Witham TF, Kondziolka D, Lunsford LD, Bozik M, Schiff D
Department
of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania,
USA
Objective.
To determine the risks and survival benefit associated with implantation of an
absorbable, 1,3-bis(2chloroethyl)-1-nitrosourea-impregnated polymer wafer, we
prospectively studied patients with recurrent glioblastoma multiforme and
compared them with a demographically matched cohort group.
Methods.
Over a 29-month period, 62 patients underwent operations.
All had tumor growth despite standard treatment, a Karnofsky performance score
of > or =70, and histopathological confirmation of glioblastoma.
Seventeen patients underwent gross total resection with placement of
1,3-bis(2-chloroethyl)-1-nitrosourea wafers (wafer group) at a median 44 weeks
from diagnosis (6 women, 11 men; median age, 56 years).
A cohort group of 45 patients undergoing surgery for recurrent glioblastoma
during the same time period, but not receiving wafers, was identified.
Surgery was performed at a median 47 weeks from diagnosis (14 women, 31 men;
median age, 54 years).
Results.
Within 6 weeks of surgery, 13 complications were identified in 8 patients in the
wafer group.
In the cohort group, 6 patients sustained 8 complications.
We were unable to identify any survival advantage using Kaplan-Meier analysis.
In the wafer group, median survival was 58 weeks from diagnosis and 14 weeks
from wafer implantation.
In the cohort group, median survival was 97 weeks from diagnosis and 50 weeks
from operation.
Conclusion.
1,3-bis(2-chloroethyl)-1-Nitrosourea wafer implantation for recurrent
glioblastoma was associated with a higher risk of postoperative complications,
particularly those related to infection and wound healing.
No clear survival benefit associated with wafer implantation was identified.
PMID:
10414561 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10414561&dopt=Abstract |
