title: Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control.
abstract: OBJECTIVE
  To define the safety and efficacy of carmustine polymer wafers when added to a regimen of surgery and external beam radiotherapy for treatment of a single brain metastasis.
  
  
  METHODS
  Adult patients underwent craniotomy for a single brain metastasis, and carmustine polymer wafers were placed in the tumor resection cavity. Patients then received whole-brain radiotherapy and were followed for patterns of recurrence in the central nervous system, toxicity, and survival.
  
  
  RESULTS
  We enrolled 25 patients with solitary brain metastases from lung (13 patients), melanoma (4 patients), breast (3 patients), and renal carcinoma (3 patients). Two patients had severe adverse events thought to be related to wafer placement, one with seizures alone, and one with seizures and subsequent respiratory compromise. Both responded to medical therapy. There were no wound infections. The local recurrence rate was surprisingly low (0%). Four patients (16%) relapsed elsewhere in the brain, and two patients (8%) relapsed in the spinal cord. Median survival was 33 weeks; 33% of patients survived 1 year, and 25% survived 2 years.
  
  
  CONCLUSIONS
  The addition of local chemotherapy delivered via carmustine polymer wafers to a regimen of surgical resection and external beam radiotherapy was well tolerated by patients undergoing surgery for a single brain metastasis. There were no local recurrences, suggesting that this treatment further reduced the risk of local relapse.
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. ewend@med.unc.edu
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
authors.forename: Steven
authors.initials: S
authors.lastname: Brem
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.forename: Robert
authors.initials: R
authors.lastname: Goodkin
authors.forename: Paul L
authors.initials: PL
authors.lastname: Penar
authors.forename: Mahesh
authors.initials: M
authors.lastname: Varia
authors.forename: Sharon
authors.initials: S
authors.lastname: Cush
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D002330:Carmustine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004343:Drug Implants; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011878:Radiotherapy; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004343:Drug Implants; D002330:Carmustine