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 D. Weingart, Alessandro Olivi, Alfredo Quinones-Hinojosa, Henry Brem

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161 Scopus citations

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 1 2008

Keywords

  • Complications
  • Gliadel
  • Malignant astrocytoma
  • Polymer delivery

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Attenello, F. J., Mukherjee, D., Datoo, G., McGirt, M. J., Bohan, E., Weingart, J. D., Olivi, A., Quinones-Hinojosa, A., & Brem, H. (2008). Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: A 10-year institutional experience. Annals of surgical oncology, 15(10), 2887-2893. https://doi.org/10.1245/s10434-008-0048-2