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The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis.

Xing WK, Shao C, Qi ZY, Yang C, Wang Z - Drug Des Devel Ther (2015)

Bottom Line: Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR = 0.51, 95% CI = 0.18-1.41; P = 0.426), while the cohort studies demonstrated a significant survival increase (HR = 0.59, 95% CI = 0.44-0.79; P < 0.0001).Carmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.

ABSTRACT

Background: Standard treatment for high-grade glioma (HGG) includes surgery followed by radiotherapy and/or chemotherapy. Insertion of carmustine wafers into the resection cavity as a treatment for malignant glioma is currently a controversial topic among neurosurgeons. Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).

Method: We searched the PubMed and Web of Science databases without any restrictions on language using the keywords "Gliadel wafers", "carmustine wafers", "BCNU wafers", or "interstitial chemotherapy" in newly diagnosed GBM for the period from January 1990 to March 2015. Randomized controlled trials (RCTs) and cohort studies/clinical trials that compared treatments designed with and without carmustine wafers and which reported overall survival or hazard ratio (HR) or survival curves were included in this study. Moreover, the statistical analysis was conducted by the STATA 12.0 software.

Results: Six studies including two RCTs and four cohort studies, enrolling a total of 513 patients (223 with and 290 without carmustine wafers), matched the selection criteria. Carmustine wafers showed a strong advantage when pooling all the included studies (HR = 0.63, 95% confidence interval (CI) = 0.49-0.81; P = 0.019). However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR = 0.51, 95% CI = 0.18-1.41; P = 0.426), while the cohort studies demonstrated a significant survival increase (HR = 0.59, 95% CI = 0.44-0.79; P < 0.0001).

Conclusion: Carmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM. More studies should be designed for newly diagnosed GBM in the future.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the studies chosen for this analysis.
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f1-dddt-9-3341: Flow chart of the studies chosen for this analysis.

Mentions: A flow chart of the steps in choosing the included studies is shown in Figure 1. The search strategy identified 291 relevant articles screened in the PubMed and Web of Science databases. We excluded 256 unrelated themes and had 35 articles for detailed evaluation. Ten reviews were excluded from further analyses.12,21–29 Nineteen of the remaining 25 studies were excluded after reading the full texts. Thirteen of them were excluded because the data on comparison between groups with and without carmustine wafers in the studies were not valid or because there was no comparison in them.30–42 Because of the treatment bias, the survival comparison was not the aim of another study.43 Two articles44,45 used the same experimental data from the study by Westphal et al.6 One study did not present the survival data and we could not contact the author using the email provided in his article.46 The study focusing on recurrent GBM was also excluded.47 Finally, seven studies were included in our research.6–8,10,48–50 Because the same RCT study by Westphal et al6,50 was reported in both 2003 and 2006, we included the latest follow-up study for further analysis. Thus, a total of six studies were included in this meta-analysis.7,8,10,48–50


The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis.

Xing WK, Shao C, Qi ZY, Yang C, Wang Z - Drug Des Devel Ther (2015)

Flow chart of the studies chosen for this analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492653&req=5

f1-dddt-9-3341: Flow chart of the studies chosen for this analysis.
Mentions: A flow chart of the steps in choosing the included studies is shown in Figure 1. The search strategy identified 291 relevant articles screened in the PubMed and Web of Science databases. We excluded 256 unrelated themes and had 35 articles for detailed evaluation. Ten reviews were excluded from further analyses.12,21–29 Nineteen of the remaining 25 studies were excluded after reading the full texts. Thirteen of them were excluded because the data on comparison between groups with and without carmustine wafers in the studies were not valid or because there was no comparison in them.30–42 Because of the treatment bias, the survival comparison was not the aim of another study.43 Two articles44,45 used the same experimental data from the study by Westphal et al.6 One study did not present the survival data and we could not contact the author using the email provided in his article.46 The study focusing on recurrent GBM was also excluded.47 Finally, seven studies were included in our research.6–8,10,48–50 Because the same RCT study by Westphal et al6,50 was reported in both 2003 and 2006, we included the latest follow-up study for further analysis. Thus, a total of six studies were included in this meta-analysis.7,8,10,48–50

Bottom Line: Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR = 0.51, 95% CI = 0.18-1.41; P = 0.426), while the cohort studies demonstrated a significant survival increase (HR = 0.59, 95% CI = 0.44-0.79; P < 0.0001).Carmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.

ABSTRACT

Background: Standard treatment for high-grade glioma (HGG) includes surgery followed by radiotherapy and/or chemotherapy. Insertion of carmustine wafers into the resection cavity as a treatment for malignant glioma is currently a controversial topic among neurosurgeons. Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).

Method: We searched the PubMed and Web of Science databases without any restrictions on language using the keywords "Gliadel wafers", "carmustine wafers", "BCNU wafers", or "interstitial chemotherapy" in newly diagnosed GBM for the period from January 1990 to March 2015. Randomized controlled trials (RCTs) and cohort studies/clinical trials that compared treatments designed with and without carmustine wafers and which reported overall survival or hazard ratio (HR) or survival curves were included in this study. Moreover, the statistical analysis was conducted by the STATA 12.0 software.

Results: Six studies including two RCTs and four cohort studies, enrolling a total of 513 patients (223 with and 290 without carmustine wafers), matched the selection criteria. Carmustine wafers showed a strong advantage when pooling all the included studies (HR = 0.63, 95% confidence interval (CI) = 0.49-0.81; P = 0.019). However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR = 0.51, 95% CI = 0.18-1.41; P = 0.426), while the cohort studies demonstrated a significant survival increase (HR = 0.59, 95% CI = 0.44-0.79; P < 0.0001).

Conclusion: Carmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM. More studies should be designed for newly diagnosed GBM in the future.

No MeSH data available.


Related in: MedlinePlus