Repeated Implantation of Interstitial Chemotherapy to Treat Malignant Gliomas

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Abstract

Objective and Importance

A detailed review of a patient diagnosed with recurrent malignant glioma (MG) who received repeated implantations of BCNU wafers is presented. Twelve additional cases of repeat wafer implantation in patients with MG are summarized.

Clinical Presentation and Intervention

A 25-year-old female patient presented with glioblastoma multiforme. Multimodal therapy that included surgery, radiotherapy, and chemotherapy was initiated. Subsequently, the patient experienced 3 disease recurrences; the patient was treated with surgery and carmustine (BCNU) wafers for the first and second recurrences and with PCV for the third recurrence. The patient was alive at last available follow-up. Repeated implantation of BCNU wafers was used in 12 additional patients. Of these 13 total patients, 4 were alive at last available follow-up. For the 9 patients who died, median survival from the time of second craniotomy was 8 months (range: 4 to 40 mo). Serious adverse events were consistent with those seen in previous local chemotherapy trials in patients with recurrent MG.

Conclusions

The data obtained in this report suggest that repeated implantation of BCNU wafers within a multimodal treatment strategy is feasible and well tolerated. Further study is required to determine the safety and efficacy of repeated implantation.

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