PURPOSE: Retrospective study of patients treated for high-grade glioma, with or 
without biodegradable carmustine wafers and according to the Stupp protocol.
METHODS AND MATERIALS: Between May 2007 and June 2008, 65 patients underwent 
surgery for high-grade glioma, 28 had implantation of Gliadel and 37 patients 
did not. Patients received radiotherapy with concomitant temozolomide followed 
by 5 consecutive days of temozolomide every month for 6 months.
RESULTS: Overall median follow-up was 17.1 months; the median relapse-free 
survival (RFS) was 14 months with a RFS of 54% at 12 months, and 38% at 24 
months. For patient with and without Gliadel, median and 1-year RFS were 12.9 
months and 52% vs. 14 months and 42%, respectively (p = 0.89). According to 
pathology, Gliadel did not influence RFS of patients with Grade III or 
glioblastoma. However, for all patients, in multivariate analysis, 
non-methylated methylguanine methyltransferase (MGMT) was the only unfavorable 
prognostic factor of RFS (p = 0.017; HR 2.8; CI [1.2-7]). Median overall 
survival (OS) was 20.8 months; the OS rate at 12 months was 78.5%, and at 24 
months 35.4%. For patients treated with and without Gliadel, median and 1-year 
OS were 20.6 months and 78.6% vs. 20.8 months and 78.4%, respectively. According 
to pathology, Gliadel did not influence OS of patients with Grade III or 
glioblastoma. For all patients, in multivariate analysis, unfavorable 
prognosticators for OS were non-methylated MGMT (p = 0.001; HR: 6.5; CI [2-20]) 
and irradiation dose <60 Gy (p = 0.02; HR: 6.3; CI [2-20]). With carmustine 
wafers, before irradiation, median gross tumor volume plus edema was 84 mL 
(27-229), whereas it was 68 mL (10-362) without carmustine (p = nonsignificant). 
Four cases of Grade 3 thrombopenia occurred, all in the carmustine wafer group.
CONCLUSION: In patients with high-grade gliomas, adding Gliadel before 
performing a Stupp protocol did not improve survival.