Carmustine Wafers (Gliadel) Plus Concomitant Temozolomide Therapy After Resection of Malignant Astrocytoma: Growing Evidence for Safety and Efficacy

Abstract

Menei and colleagues have performed a thorough analysis in their retrospective cohort study from 26 centers in France. They report the overall survival and complication rate associated with the adjuvant use of implantable biodegradable carmustine wafers (Gliadel; MGI Pharma, Bloomington, MN; now Eisai Inc.) for the treatment of primary and recurrent malignant astrocytoma (MA). The authors also investigate the independent association of morbidity and overall survival with combination therapy of temozolomide (TMZ, Stupp protocol) and Gliadel implantation after surgical resection. 1,2 In their series of 83 primary and 80 recurrent MA treated with surgical resection plus Gliadel implantation, the authors report a median survival of 7 months after revision resection of recurrent MA and 17 months after primary resection of MA. For the 43 patients receiving both Gliadel and Stupp protocol after primary resection of MA, a median survival of 608 days (approximately 19.9 months) was observed. Consistent with previous studies, factors independently associated with survival were fractionated radiotherapy, Karnofsky performance score, and extent of resection. The proportions of these prognostic variables were comparable to prior Gliadel series. This series of Gliadel implantation used a variety of adjuvant radiation and chemotherapy regimens. Hence, the overall survival was greater than those previously reported in randomized trails of Gliadel for primary MA. 3,4 Although the retro