Abstract 352P
Background
Standard primary surgical management of glioblastoma is maximal safe de-bulking. In the United Kingdom, for those patients’ where more than 90% of de-bulking is possible, carmustine wafers (Gliadel) have been approved for insertion along the operative bed. (NICE TA121 2007). Although a meta-analysis of 513 patients demonstrated a survival advantage of gliadel wafer insertion. (Xing et al 2015), the usage varies within different neuro surgical centres. In this retrospective analysis we look at our tertiary neuro surgical centre experience in this clinical scenario.
Methods
We collected data from 110 patients who completed standard treatment of adjuvant chemoradiotherapy following neurosurgery from 2007 to 2016. Data were reviewed from surgical entry and oncology records. Patients who did not receive adjuvant chemoradiotherapy within 3 months due to post op complications from Gliadel wafers were excluded in the final analysis.
Results
The median age was 60 years and median overall survival was 16 months for the entire cohort. Maximal debulking was achieved in 39%, partial de-bulking in 50% and 11% had biopsy only. For patients who had gliadel wafer insertion, median overall survival was 19.5 months (95% confidence interval 14-30) for those without wafers median overall survival was 16 months (95% confidence interval 14 – 21), P=0.06. On Cox regression analysis Gliadel wafer insertion was a statistically significant predictor of overall survival, P-Value, 0.008. Progression-free survival was not significantly significant with the insertion of Gliadel wafers. It was 12.2 (10.43-19.7) months with wafer insertion and 11.8 (8.93-15) without.
Conclusions
Within our select cohort of glioblastoma patients, carmustine wafer insertion at the time of primary de-bulking surgery showed improved overall survival without impacting the progression free survival.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
L. Price.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.