The role of interstitial BCNU chemotherapy in the treatment of malignant glioma.
BACKGROUND
Use of interstitial BCNU wafers in the treatment of malignant glioma is currently a controversial topic among neurosurgeons. Initial clinical studies indicated implantation of BCNU wafers into the postoperative tumor bed to be an acceptably safe, partially effective treatment for glioblastoma multiforme. Yet a more recent study has put the efficacy of this treatment in doubt, and there are potential complications associated with BCNU wafer use.


OBJECTIVE
This article presents a review of the information presently available on BCNU wafers-both pro and con-to aid in the clinical decision-making process. The article focuses on studies of clinical efficacy (for initial use as well as in the setting of recurrent tumor), complications associated with BCNU wafers, and the experimental data, particularly related to BCNU penetration into the brain.


RESULTS
Animal studies and computer simulations have shown that the depth of penetration of BCNU from wafers is limited. Yet in actual clinical use, the interstitial pressure within the wafer-laden tumor bed might be higher, convective flow greater, and delivery of BCNU to the brain more significant than predicted.


CONCLUSIONS
Based on current information, use of interstitial BCNU wafers continues to be an option for treating malignant glioma. Additional clinical studies of BCNU wafers are currently underway.
Engelhard
H H
HH
Department of Neurosurgery, The University of Illinois at Chicago, 60612, USA.
D000818:Animals; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D001672:Biocompatible Materials; D001932:Brain Neoplasms / Q000188:drug therapy*; D002330:Carmustine / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic; D004333:Drug Administration Routes; D004343:Drug Implants / Q000009:adverse effects; D005909:Glioblastoma / Q000188:drug therapy; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D001672:Biocompatible Materials; D004343:Drug Implants; D002330:Carmustine