AUTHOR=Ricciardi Luca , Manini Ivana , Cesselli Daniela , Trungu Sokol , Piazza Amedeo , Mangraviti Antonella , Miscusi Massimo , Raco Antonino , Ius Tamara 

TITLE=Carmustine Wafers Implantation in Patients With Newly Diagnosed High Grade Glioma: Is It Still an Option?

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.884158

DOI=10.3389/fneur.2022.884158

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>The implantation protocol for Carmustine Wafers (CWs) in high grade glioma (HGG) was developed to offer a bridge between surgical resection and adjuvant treatments, such as radio- and chemotherapy. In the last years, however, a widespread use of CWs has been limited due to uncertainties regarding efficacy, in addition to increased risk of infection and elevated costs of treatment.</p></sec><sec><title>Objective</title><p>The aims of our study were to investigate the epidemiology of patients that underwent surgery for HGG with CW implantation, in addition to the assessment of related complications, long-term overall survival (<italic>OS</italic>), and associated prognostic factors.</p></sec><sec><title>Methods</title><p>Three different medical databases were screened for conducting a systematic review of the literature, according to the PRISMA statement guidelines, evaluating the role of BCNU wafer implantation in patients with newly diagnosed HGG. The search query was based on a combination of medical subject headings (MeSH): “high grade glioma” [MeSH] AND “Carmustine” [MeSH] and free text terms: “surgery” OR “BCNU wafer” OR “Gliadel” OR “systemic treatment options” OR “overall survival.”</p></sec><sec><title>Results</title><p>The analysis of the meta-data demonstrated that there was a significant advantage in using CWs in newly diagnosed GBM in terms of <italic>OS</italic>, and a very low heterogeneity among the included studies [mean difference 2.64 (95% <italic>CI</italic> 0.85, 4.44); <italic>p</italic> = 0.004; I2149 = 0%]. Conversely, no significant difference between the two treatment groups in terms of PFS wad detected (<italic>p</italic> = 0.55). The analysis of complications showed a relatively higher rate in Carmustine implanted patients, although this difference was not significant (<italic>p</italic> = 0.53).</p></sec><sec><title>Conclusions</title><p>This meta-analysis seems to suggest that CWs implantation plays a significant role in improving the <italic>OS</italic>, when used in patients with newly diagnosed HGG. To minimize the risk of side effects, however, a carful patient selection based mainly on patient age and tumor volume should be desirable.</p></sec>