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Master Thesis

Évaluation monocentrique de l'implantation de pastilles de carmustine au sein du foyer opératoire de glioblastomes‎ : revue de la littérature‎ : justification du développement de techniques d'infusion convective dans le traitement des gliomes

Abstract : Objectives: To study the therapeutic efficiency of a local chemotherapy in the management of glioblastomas, comparison with literature datas. Materials and methods : this is a retrospective, monocentric study including all the patients with a carmustine wafer (Gliadel®) implantation an histologic diagnosis of WHO grade 4 glioma xere required. The inclusion period is from 2006 to 2008, 46 patients were concerned. Primary endpoints are progression-free survival and overall survival. Adverse events reliable to this therapeutic strategy were also assessed. Our results are compared to historical series. Results: Median progression free survival is 34 weeks and overall survival median is 70 weeks. Historical studies analysis of populations with similar prognosis factor cannot provides significant differences concerning patients survival when carmustine wafers are implanted. Adverse events are acceptable in their frequency, (around 10% in our study). Theses complications are miscellaneous : brain oedema (2,12%), CSF leakage (2,12%), resection cavity haematoma (4,24%). Literature review and conclusions: Prospective and randomized studies conclusions about efficacy of carmustine wafers implantation in the high-grade glioma treatment are not evidence-based, due to important methodological bias and clear disclosures. Adverse events linked to carmustine wafers are preventable, when guidelines of use are respected, especially the fact that a macroscopic removal is required before the implantation. An analysis of the pharmacokinetics properties of carmustine wafers and local parameters of mass transfer, gives us an explanation to the lack of therapeutic efficiency.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00746523
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Submitted on : Monday, October 29, 2012 - 11:54:09 AM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM
Long-term archiving on: : Saturday, December 17, 2016 - 5:46:50 AM

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  • HAL Id : dumas-00746523, version 1

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Laurent Selek. Évaluation monocentrique de l'implantation de pastilles de carmustine au sein du foyer opératoire de glioblastomes‎ : revue de la littérature‎ : justification du développement de techniques d'infusion convective dans le traitement des gliomes. Médecine humaine et pathologie. 2012. ⟨dumas-00746523⟩

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