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Open Access 01-01-2018 | Clinical Study

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

Authors: William Sage, Mathew Guilfoyle, Catriona Luney, Adam Young, Rohitashwa Sinha, Donatella Sgubin, Joseph H. McAbee, Ruichong Ma, Sarah Jefferies, Rajesh Jena, Fiona Harris, Kieren Allinson, Tomasz Matys, Wendi Qian, Thomas Santarius, Stephen Price, Colin Watts

Published in: Journal of Neuro-Oncology | Issue 2/2018

Abstract

Grade IV glioma is the most common and aggressive primary brain tumour. Gross total resection with 5-aminolevulinic acid (5-ALA) guided surgery combined with local chemotherapy (carmustine wafers) is an attractive treatment strategy in these patients. No previous studies have examined the benefit carmustine wafers in a treatment programme of 5-ALA guided resection followed by a temozolomide-based chemoradiotherapy protocol. The objective of this study was to examine the benefit of carmustine wafers on survival in patients undergoing 5-ALA guided resection. A retrospective cohort study of 260 patients who underwent 5-ALA resection of confirmed WHO 2007 Grade IV glioma between July 2009 and December 2014. Survival curves were calculated using the Kaplan–Meier method from surgery. The log-rank test was used to compare survival curves between groups. Cox regression was performed to identify variables predicting survival. A propensity score matched analysis was used to compare survival between patients who did and did not receive carmustine wafers while controlling for baseline characteristics. Propensity matched analysis showed no significant survival benefit of insertion of carmustine wafers over 5-ALA resection alone (HR 0.97 [0.68–1.26], p = 0.836). There was a trend to higher incidence of wound infection in those who received carmustine wafers (15.4 vs. 7.1%, p = 0.064). The Cox regression analysis showed that intraoperative residual fluorescent tumour and residual enhancing tumour on post-operative MRI were significantly predictive of reduced survival. Carmustine wafers have no added benefit following 5-ALA guided resection. Residual fluorescence and residual enhancing disease following resection have a negative impact on survival.

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Title: Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit
Authors: William Sage
Mathew Guilfoyle
Catriona Luney
Adam Young
Rohitashwa Sinha
Donatella Sgubin
Joseph H. McAbee
Ruichong Ma
Sarah Jefferies
Rajesh Jena
Fiona Harris
Kieren Allinson
Tomasz Matys
Wendi Qian
Thomas Santarius
Stephen Price
Colin Watts
Publication date: 01-01-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 2/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-017-2649-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit

Abstract

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Springer Medicine

Abstract

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