Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: A 10-year institutional experience

Frank J. Attenello, Debraj Mukherjee, Ghazala Datoo, Matthew J. McGirt, Eileen Bohan, Jon David Weingart, Alessandro Olivi, Alfredo Quinones-Hinojosa, Henry Brem

Research output: Contribution to journalArticle

Abstract

Background: Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly used for local delivery of BCNU to high-grade gliomas after resection and is associated with increased survival. Various complications of Gliadel wafers have been reported but not consistently reproduced. We set out to characterize Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for treatment of malignant glioma. Methods: We retrospectively reviewed records of 1013 patients undergoing craniotomy for resection of malignant brain astrocytoma (World Health Organization grade III/IV disease). Perioperative morbidity occurring within 3 months of surgery was assessed for patients and compared between patients receiving versus not receiving Gliadel wafer. Overall survival was assessed for all patients. Results: A total of 1013 craniotomies were performed for malignant brain astrocytoma. A total of 288 (28%) received Gliadel wafer (250 glioblastoma multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma (AA/AO), 166 primary resection, 122 revision resection). Compared with the non-Gliadel cohort, patients receiving Gliadel were older (55 ± 14 vs. 50 ± 17, P = .001) and more frequently underwent gross total resection (75% vs 36%, P <.01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had similar incidences of perioperative surgical site infection (2.8% vs. 1.8%, P = .33), cerebrospinal fluid leak (2.8% vs. 1.8%, P = .33), meninigitis (.3% vs. .3%, P = 1.00), incisional wound healing difficulty (.7% vs. .4%, P = .63), symptomatic malignant edema (2.1% vs. 2.3%, P = 1.00), 3-month seizure incidence (14.6% vs. 15.7%, P = .65), deep-vein thrombosis (6.3% vs. 5.2%, P = .53), and pulmonary embolism (PE) (4.9% vs. 3.7%, P = .41). For patients receiving Gliadel for GBM, median survival was 13.5 months after primary resection (20% alive at 2 years) and 11.3 months after revision resection (13% alive at 2 years). For patients receiving Gliadel for AA/AO, median survival was 57 months after primary resection (66% alive at 2 years) and 23.6 months after revision resection (47% alive at 2 years). Conclusion: In our experience, use of Gliadel wafer was not associated with an increase in perioperative morbidity after surgical treatment of malignant astrocytoma.

Original languageEnglish (US)
Pages (from-to)2887-2893
Number of pages7
JournalAnnals of Surgical Oncology
Volume15
Issue number10
DOIs
StatePublished - Oct 2008

Fingerprint

Carmustine
antineoplaston A10
Glioma
Astrocytoma
Therapeutics
Oligodendroglioma
Survival
Craniotomy
Glioblastoma
Morbidity
poliferprosan 20 drug combination carmustine
Surgical Wound Infection
Incidence
Brain
Pulmonary Embolism
Venous Thrombosis
Wound Healing
Edema
Seizures

Keywords

  • Complications
  • Gliadel
  • Malignant astrocytoma
  • Polymer delivery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma : A 10-year institutional experience. / Attenello, Frank J.; Mukherjee, Debraj; Datoo, Ghazala; McGirt, Matthew J.; Bohan, Eileen; Weingart, Jon David; Olivi, Alessandro; Quinones-Hinojosa, Alfredo; Brem, Henry.

In: Annals of Surgical Oncology, Vol. 15, No. 10, 10.2008, p. 2887-2893.

Research output: Contribution to journalArticle

Attenello, Frank J. ; Mukherjee, Debraj ; Datoo, Ghazala ; McGirt, Matthew J. ; Bohan, Eileen ; Weingart, Jon David ; Olivi, Alessandro ; Quinones-Hinojosa, Alfredo ; Brem, Henry. / Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma : A 10-year institutional experience. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 10. pp. 2887-2893.
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abstract = "Background: Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly used for local delivery of BCNU to high-grade gliomas after resection and is associated with increased survival. Various complications of Gliadel wafers have been reported but not consistently reproduced. We set out to characterize Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for treatment of malignant glioma. Methods: We retrospectively reviewed records of 1013 patients undergoing craniotomy for resection of malignant brain astrocytoma (World Health Organization grade III/IV disease). Perioperative morbidity occurring within 3 months of surgery was assessed for patients and compared between patients receiving versus not receiving Gliadel wafer. Overall survival was assessed for all patients. Results: A total of 1013 craniotomies were performed for malignant brain astrocytoma. A total of 288 (28{\%}) received Gliadel wafer (250 glioblastoma multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma (AA/AO), 166 primary resection, 122 revision resection). Compared with the non-Gliadel cohort, patients receiving Gliadel were older (55 ± 14 vs. 50 ± 17, P = .001) and more frequently underwent gross total resection (75{\%} vs 36{\%}, P <.01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had similar incidences of perioperative surgical site infection (2.8{\%} vs. 1.8{\%}, P = .33), cerebrospinal fluid leak (2.8{\%} vs. 1.8{\%}, P = .33), meninigitis (.3{\%} vs. .3{\%}, P = 1.00), incisional wound healing difficulty (.7{\%} vs. .4{\%}, P = .63), symptomatic malignant edema (2.1{\%} vs. 2.3{\%}, P = 1.00), 3-month seizure incidence (14.6{\%} vs. 15.7{\%}, P = .65), deep-vein thrombosis (6.3{\%} vs. 5.2{\%}, P = .53), and pulmonary embolism (PE) (4.9{\%} vs. 3.7{\%}, P = .41). For patients receiving Gliadel for GBM, median survival was 13.5 months after primary resection (20{\%} alive at 2 years) and 11.3 months after revision resection (13{\%} alive at 2 years). For patients receiving Gliadel for AA/AO, median survival was 57 months after primary resection (66{\%} alive at 2 years) and 23.6 months after revision resection (47{\%} alive at 2 years). Conclusion: In our experience, use of Gliadel wafer was not associated with an increase in perioperative morbidity after surgical treatment of malignant astrocytoma.",
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author = "Attenello, {Frank J.} and Debraj Mukherjee and Ghazala Datoo and McGirt, {Matthew J.} and Eileen Bohan and Weingart, {Jon David} and Alessandro Olivi and Alfredo Quinones-Hinojosa and Henry Brem",
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TY - JOUR

T1 - Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma

T2 - A 10-year institutional experience

AU - Attenello, Frank J.

AU - Mukherjee, Debraj

AU - Datoo, Ghazala

AU - McGirt, Matthew J.

AU - Bohan, Eileen

AU - Weingart, Jon David

AU - Olivi, Alessandro

AU - Quinones-Hinojosa, Alfredo

AU - Brem, Henry

PY - 2008/10

Y1 - 2008/10

N2 - Background: Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly used for local delivery of BCNU to high-grade gliomas after resection and is associated with increased survival. Various complications of Gliadel wafers have been reported but not consistently reproduced. We set out to characterize Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for treatment of malignant glioma. Methods: We retrospectively reviewed records of 1013 patients undergoing craniotomy for resection of malignant brain astrocytoma (World Health Organization grade III/IV disease). Perioperative morbidity occurring within 3 months of surgery was assessed for patients and compared between patients receiving versus not receiving Gliadel wafer. Overall survival was assessed for all patients. Results: A total of 1013 craniotomies were performed for malignant brain astrocytoma. A total of 288 (28%) received Gliadel wafer (250 glioblastoma multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma (AA/AO), 166 primary resection, 122 revision resection). Compared with the non-Gliadel cohort, patients receiving Gliadel were older (55 ± 14 vs. 50 ± 17, P = .001) and more frequently underwent gross total resection (75% vs 36%, P <.01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had similar incidences of perioperative surgical site infection (2.8% vs. 1.8%, P = .33), cerebrospinal fluid leak (2.8% vs. 1.8%, P = .33), meninigitis (.3% vs. .3%, P = 1.00), incisional wound healing difficulty (.7% vs. .4%, P = .63), symptomatic malignant edema (2.1% vs. 2.3%, P = 1.00), 3-month seizure incidence (14.6% vs. 15.7%, P = .65), deep-vein thrombosis (6.3% vs. 5.2%, P = .53), and pulmonary embolism (PE) (4.9% vs. 3.7%, P = .41). For patients receiving Gliadel for GBM, median survival was 13.5 months after primary resection (20% alive at 2 years) and 11.3 months after revision resection (13% alive at 2 years). For patients receiving Gliadel for AA/AO, median survival was 57 months after primary resection (66% alive at 2 years) and 23.6 months after revision resection (47% alive at 2 years). Conclusion: In our experience, use of Gliadel wafer was not associated with an increase in perioperative morbidity after surgical treatment of malignant astrocytoma.

AB - Background: Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly used for local delivery of BCNU to high-grade gliomas after resection and is associated with increased survival. Various complications of Gliadel wafers have been reported but not consistently reproduced. We set out to characterize Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for treatment of malignant glioma. Methods: We retrospectively reviewed records of 1013 patients undergoing craniotomy for resection of malignant brain astrocytoma (World Health Organization grade III/IV disease). Perioperative morbidity occurring within 3 months of surgery was assessed for patients and compared between patients receiving versus not receiving Gliadel wafer. Overall survival was assessed for all patients. Results: A total of 1013 craniotomies were performed for malignant brain astrocytoma. A total of 288 (28%) received Gliadel wafer (250 glioblastoma multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma (AA/AO), 166 primary resection, 122 revision resection). Compared with the non-Gliadel cohort, patients receiving Gliadel were older (55 ± 14 vs. 50 ± 17, P = .001) and more frequently underwent gross total resection (75% vs 36%, P <.01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had similar incidences of perioperative surgical site infection (2.8% vs. 1.8%, P = .33), cerebrospinal fluid leak (2.8% vs. 1.8%, P = .33), meninigitis (.3% vs. .3%, P = 1.00), incisional wound healing difficulty (.7% vs. .4%, P = .63), symptomatic malignant edema (2.1% vs. 2.3%, P = 1.00), 3-month seizure incidence (14.6% vs. 15.7%, P = .65), deep-vein thrombosis (6.3% vs. 5.2%, P = .53), and pulmonary embolism (PE) (4.9% vs. 3.7%, P = .41). For patients receiving Gliadel for GBM, median survival was 13.5 months after primary resection (20% alive at 2 years) and 11.3 months after revision resection (13% alive at 2 years). For patients receiving Gliadel for AA/AO, median survival was 57 months after primary resection (66% alive at 2 years) and 23.6 months after revision resection (47% alive at 2 years). Conclusion: In our experience, use of Gliadel wafer was not associated with an increase in perioperative morbidity after surgical treatment of malignant astrocytoma.

KW - Complications

KW - Gliadel

KW - Malignant astrocytoma

KW - Polymer delivery

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