Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme.
OBJECTIVE
Effective treatment options are limited for patients with recurrent glioblastoma multiforme (GBM), and survival is usually <1 year. Novel treatment approaches are needed. Localized adjunct treatment with carmustine (BCNU) wafers or permanent, low-activity 125I seed implants has been shown to be effective for GBM. This study assessed the efficacy and safety of these therapies in combination following tumor resection.


METHODS
Thirty-four patients with recurrent GBM were treated with maximal tumor resection followed by implantation of BCNU wafers and permanent 125I seeds into the tumor cavity. Patients were followed up with clinical evaluations and magnetic resonance imaging studies once every 3 months. Survival and progression-free survival (PFS) were evaluated.


RESULTS
During follow-up, local disease progression was observed in 27 patients, and 23 of them died. The median survival period was 69 weeks, and the median PFS was 47 weeks. The 12-month survival and PFS rates were 66 and 32%, respectively. Baseline factors associated with prolonged survival included Karnofsky Performance Scale score>or=70, 125I seed activity>or=0.8 mCi/cm3 of tumor cavity, and age<60 years. Brain necrosis developed in 8 patients (24%) and was successfully treated with surgery or hyperbaric oxygen therapy.


CONCLUSIONS
The use of adjunct therapy combining BCNU wafers and permanent 125I seeds resulted in survival that compares favorably with data from similar studies performed in patients with recurrent GBM. The incidence of brain necrosis appeared to be higher than that expected with either treatment alone, although the necrosis was manageable and did not affect survival. This novel approach warrants further investigation in recurrent and newly diagnosed GBM.
Darakchiev
Borimir J
BJ
Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0515, USA.
Albright
Robert E
RE
Breneman
John C
JC
Warnick
Ronald E
RE
D000367:Age Factors; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001918:Brachytherapy / Q000295:instrumentation*; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000601:surgery*; D002330:Carmustine / Q000008:administration & dosage*; D018450:Disease Progression; D018572:Disease-Free Survival; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012449:Safety; D015996:Survival Rate; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D004343:Drug Implants; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D002330:Carmustine