BACKGROUND Carmustine wafers (CW) are approved to treat newly or recurrent high-grade gliomas (HGG). Widespread use has been limited regarding some doubtful uncertainties about their efficacy, related increased risk of infection and expensive cost. OBJECTIVE To describe the epidemiology of CW implantation, search for related complications, long-term survival and associated prognostic factors. METHODS We processed the French medico-administrative national database to retrieve appropriate cases operated between 2010 and 2018. A survival analysis was conducted. RESULTS We identified 1659 patients treated in 39 institutions. Median age at CW implantation was 61 years and there was an over-representation of male (63.5%). 491 patients (29.6%) had previous diagnosis of glioma. Time between the first surgery and CW implantation was 0.9 years, IQR[0.6, 1.6]. The frontal lobe was the most frequently involved 29%. 131 patients (7.9%) had to be re operated on for a complication of which 121 for surgical site infection. At one year, 514 patients (31%) had died. Median overall survival (OS) was 1.4 years, 95% CI [1.3, 1.5]. OS at 1 and 2 year was 66%, 95%CI [63.7, 68.5], 32.3%, 95%CI [29.9, 35]. In the adjusted Cox regression, male gender & age at CW implantation were established as independent factors of OS in all three groups. Patients with recurrent HGG have a significant worse prognosis (HR = 0.71, 95% CI [0.62, 0.80] p < 0.001). A post-operative diagnosis of infection or intracranial bleeding eventually leading to a redo surgery was not associated with a decrease OS. CONCLUSION Over the past 9 years, there is a significant decrease utilisation of CW in France. OS after CW implantation is significantly variable as influenced by many factors such as age, gender or recurrent disease but not by post-operative complications. Compare to previous results, CW may increase the OS and this effect seems more pronounced when adjuvant RT/TMZ is given.

中文翻译：

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植入卡莫司汀薄饼（Gliadel®）以进行高级神经胶质瘤治疗。一项为期9年的全国回顾性研究。

背景技术卡莫斯汀薄饼（CW）被批准用于治疗新的或复发的高级神经胶质瘤（HGG）。由于其有效性，相关的感染风险增加和成本昂贵等一些不确定性，广泛使用受到限制。目的描述CW植入的流行病学，寻找相关的并发症，长期生存和相关的预后因素。方法我们处理了法国国家医疗行政管理数据库，以检索2010年至2018年之间手术的适当病例。进行了生存分析。结果我们确定了39个机构中的1659名患者。CW植入时的中位年龄为61岁，男性比例过高（63.5％）。先前有胶质瘤诊断者491例（29.6％）。从首次手术到CW植入的时间为0.9年，IQR [0.6，1.6]。额叶最常累及29％。131例患者（占7.9％）因并发症而需要再次手术，其中121例是手术部位感染。一年后，有514名患者（31％）死亡。中位总体生存期（OS）为1.4年，CI值为95％[1.3，1.5]。第1年和第2年的OS为66％，95％CI [63.7、68.5]，32.3％，95％CI [29.9、35]。在调整后的Cox回归中，在所有三组中，男性和性别随CW植入被确定为OS的独立因素。复发性HGG患者的预后明显较差（HR = 0.71，95％CI [0.62，0.80] p <0.001）。术后导致感染或颅内出血并最终导致重做手术的诊断与OS降低无关。结论在过去的9年中，法国的CW利用率显着下降。CW植入后的OS显着变化，受年龄，性别或复发性疾病等许多因素的影响，但不受术后并发症的影响。与以前的结果相比，CW可能会增加OS，并且当给予辅助性RT / TMZ时，这种效果似乎更加明显。