Is Carmustine Wafer Implantation in Progressive High-Grade Gliomas a Relevant Therapeutic Option? Complication Rate, Predictors of Complications and Onco-Functional Outcomes in a Series of 53 Cases

<b>Background/Objectives</b>: The aim was to determine the complication rate and the predictors of complications and survival in high-grade glioma surgically managed at progression with implantation of Carmustine wafers. <b>Methods</b>: A retrospective series of 53 consecutive patients operated on between 2017 and 2022 was built. <b>Results</b>: The median age was 55 ± 10.9 years. The rates of global and infectious complications were 35.8% and 18.9%, respectively. In multivariate analysis, patients with a preoperative neurological deficit were more prone to develop a postoperative complication (HR = 5.35 95% CI 1.49-19.26, <i>p</i> = 0.01). No predictor of infectious complication was identified. In the grade 4 glioma subgroup (n = 44), progression-free and overall survival (calculated starting from the reresection) reached 3.95 months, 95% CI 2.92-5.21 and 11.51 months, 95% CI 9.11-17.18, respectively. Preoperative KPS > 80% (HR = 0.97 95% CI 0.93-0.99, <i>p</i> = 0.04), Gross Total Resection (HR = 0.38 95% CI 0.18-0.80, <i>p</i> = 0.01), and 3-month postoperative KPS > 80% (HR = 0.35 95% CI 0.17-0.72, <i>p</i> = 0.004) were predictors of prolonged overall survival. <b>Conclusions</b>: Surgical resection is a relevant option in high-grade gliomas at progression, especially in patients with a preoperative KPS > 80%, without preoperative neurological deficit, and amenable to complete resection. In patients elected for surgery, Carmustine wafer implantation is associated with a high rate of complications. It is consequently critical to closely monitor the patients for whom this option is chosen.