Abstract
2070 Background: Treatment of pts with primary GBM using BCNU wafer implantation at initial surgery (Westphal, 2003) as well as the administration of TMZ concurrently and after RT (Stupp, 2005) have each been shown to increase survival. Thus, we hypothesize that the use of the combination of BCNU wafer followed by RT and concurrent (TMZ) plus rotational multi-agent chemotherapy (CCNU, TMZ, CPT-11) will increase survival compared to pts that do not receive BCNU wafers. Methods: Retrospective IRB-approved analysis was conducted on 85 eligible GBM pts who received surgery with (36 pts) and without (49 pts) BCNU wafer insertion followed by RT and concurrent (TMZ) plus adjuvant rotational multi-agent chemotherapy. Survival was estimated within treatment groups using the Kaplan-Meier method. Cox regression was used to evaluate the effect of BCNU wafers on survival after controlling for covariates such as RPA (Recursive Partition Analysis) class, race, and gender. Results: Within the non-BCNU wafer cohort, 39% of patients were younger than 50 and 89% had KPS>70%. Within the BCNU cohort, 31% of patients were younger than 50 and 94% had KPS>70. Overall 1- and 2-year survival for the non-BCNU wafer cohort was 67% (95% CI: 55%, 82%) and 27% (95% CI: 17%, 42%), respectively, with a median survival of 72.7 wks (median follow-up: 123.9; range 14.3–198). Overall 1-year survival for the BCNU wafer cohort was 78% (95% CI: 65%, 93%) with a median survival of 89.6 wks (median follow-up: 118.6; range 26.7–192.1). Given the trends towards significance (p=0.092) between the two groups using a log-rank test, a Cox regression model to control for known prognostic factors was examined: Conclusions: After controlling for the effects due to RPA class, a significant difference in survival is found between treatment groups (p = 0.0325) and patients receiving BCNU wafers have a lower risk of death (HR = 0.548) than patients not receiving BCNU wafers. [Table: see text] No significant financial relationships to disclose.
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