title: Safety and efficacy of concomitant chemotherapeutic wafers and iodine-125 seeds for recurrent glioblastoma.
abstract: BACKGROUND
  Patients with recurrent malignant gliomas have a uniformly poor prognosis. However, further treatment is often warranted at the time of recurrence. Low-activity implanted brachytherapeutic devices, such as iodine-125 seeds, and implantable chemotherapeutic devices such as 1, 3-bis (2-chloroethyl)-nitrosourea (BCNU) impregnated polymer wafers (Gliadel(®)) have been shown to be safe and modestly effective, but a comparison of combination therapy versus Gliadel(®) implantation alone has not been performed.
  
  
  METHODS
  We retrospectively examined 24 patients following re-resection of recurrent glioblastoma, with 17 patients undergoing implantation of both Gliadel(®) and iodine-125 seeds, and 7 patients undergoing implantation of Gliadel(®) only. Outcomes examined included adverse events, survival after re-resection (SAR), and time to tumor progression after re-resection (PAR).
  
  
  RESULTS
  Implantation of both Gliadel(®) and low activity iodine-125 seeds is safe with only two wound infections noted, a complication rate comparable to previous reports. The combination appears to confer a median SAR benefit if the activity per tumor resection volume exceeds 0.8 mCi/mL (60 versus 31 weeks, P = 0.02), and this benefit remained significant on multivariate analysis (HR =0.26 [CI:0.07-0.93], P = 0.03). Gross total resection of tumor was also significantly associated with longer time to PAR (HR =5.4 [CI: 1.13-26.0], P = 0.03).
  
  
  CONCLUSIONS
  The concomitant use of Gliadel(®) and low activity iodine-125 seeds following re-resection of recurrent glioblastoma is safe. Our study demonstrated a significant benefit in SAR if the iodine-125 activity per tumor volume is greater than 0.8 mCi/mL. While our sample size is small, our results are in agreement with previous studies demonstrating the efficacy of combination treatment.
authors.affiliation: Department of Neurosurgery, University of Washington, Seattle, WA 98195.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ko
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Fink
authors.forename: Keith M
authors.initials: KM
authors.lastname: Stelzer
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Silbergeld