Long-term follow-up after BCNU wafer implantation in patients with newly diagnosed glioblastoma.

Ichiyo Shibahara, Kazuhiro Miyasaka, Akane Sekiguchi, Hiromichi Ishiyama, Madoka Inukai, Yoshie Yasui, Takashi Watanabe, Sumito Sato, Takuichiro Hide, Toshihiro Kumabe

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2021 Apr

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1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU, or Carmustine) wafers are intraoperatively implantable wafers used to achieve local tumor control. There is scarce data about the behavior of wafers in the long-term follow-up of implanted cases. We reviewed the data of 64 patients with newly diagnosed glioblastoma treated by surgery, BCNU wafers, radiation therapy, and temozolomide administration. This cohort included 55 patients who presented first recurrence, and 49 of them showed tumor progression to death. The MR imaging of each patient at the terminal stage and an autopsy case were used to elucidate the tumor progression pattern after the wafer implantation. We subdivided the first recurrence pattern into local, distant, and multifocal based on MR imaging or into infield, outfield, and marginal based on the radiation field. The first recurrence pattern was 33 patients (60%) with local, 13 (24%) with distant, and nine (16%) with multifocal recurrence, or 38 patients (69%) with infield, 13 (24%) with outfield, and four (7%) with marginal. The median and mean time intervals between MR imaging at the terminal stage and death were 2.0 and 2.3 months, respectively. Of note, 13 patients with first distant recurrence had no obvious radiological local tumor progression even at the terminal stage. Long-term follow-up after BCNU wafer implantation revealed that patients with first distant recurrence had long-lasting local tumor control until the terminal stage. Copyright © 2021 Elsevier Ltd. All rights reserved.

Citation

Ichiyo Shibahara, Kazuhiro Miyasaka, Akane Sekiguchi, Hiromichi Ishiyama, Madoka Inukai, Yoshie Yasui, Takashi Watanabe, Sumito Sato, Takuichiro Hide, Toshihiro Kumabe. Long-term follow-up after BCNU wafer implantation in patients with newly diagnosed glioblastoma. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2021 Apr;86:202-210