Morbidity and survival after 1,3-bis(2-chloroethyl)-1 nitrosourea wafer implantation for recurrent glioblastoma: A retrospective case matched cohort series

OBJECTIVE: To determine the risks and survival benefit associated with impl antation of an absorbable, 1,3-bis(2-chloroethyl)-1 -nitrosourea-impregnate d polymer wafer, we! prospectively studied patients with recurrent glioblas toma multiforme and compared them with a demographically matched cohort gro up. METHODS: Over a 29-month period, 62 patients underwent operations. All had tumor growth despite standard treatment, a Karnofsky performance score of g reater than or equal to 70, and histopathological confirmation of glioblast oma. Seventeen patients underwent gross total resection with placement of 1 ,3-bis(2-chloroethyl)-1-nitrosourea wafers (wafer group) at a median 44 wee ks from diagnosis (6 women, 11 men; median age, 56 years). A cohort group o f 45 patients undergoing surgery for recurrent glioblastoma during the same time period, but not receiving wafers, was identified. Surgery was perform ed at a median 47 weeks from diagnosis (14 women, 31 men; median age, 54 ye ars). RESULTS: Within 6 weeks of surgery, 13 complications were identified in 8 p atients in the wafer group. In the cohort group, 6 patients sustained 8 com plications. We were unable to identify any survival advantage using Kaplan- Meier analysis. In the wafer group, median survival was 58 weeks from diagn osis and 14 weeks from wafer implantation. In the cohort group, median surv ival was 97 weeks from diagnosis and 50 weeks from operation. CONCLUSION: 1,3-bis(2-chloroethyl)-1-Nitrosourea wafer implantation for rec urrent glioblastoma was associated with a higher risk of postoperative comp lications, particularly those related to infection and wound healing. No cl ear survival benefit associated with wafer implantation was identified.