Loco-regional treatments in first-diagnosis glioblastoma: literature review on association between Stupp protocol and Gliadel

Loco-regional chemotherapy with carmustine wafers (Gliadel) positioned at surgery and followed by radiotherapy has been shown to prolong survival in first-diagnosis glioblastoma, as well as concomitant radiochemotherapy with temozolomide. The combination of Gliadel with the Stupp protocol has mostly been investigated in retrospective studies. objective of this study was to review the literature of efficacy and toxicities in patients with first-diagnosis glioblastoma treated with surgery, Gliadel, radiotherapy and temozolomide chemotherapy. The data in the literature regarding the combined use of Gliadel with chemotherapy, concomitant with radiotherapy and adjuvant temozolomide for glioblastoma was analyzed and compared. The results on survival and toxicity are summarized. The combination of Gliadel and radiotherapy with temozolomide is well tolerated and may increase survival without a substantial increase in major toxicity. However, only prospective comparative studies will be able to address the issue of true advantage in survival with this combination.