title: The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis.
abstract: BACKGROUND
  Standard treatment for high-grade glioma (HGG) includes surgery followed by radiotherapy and/or chemotherapy. Insertion of carmustine wafers into the resection cavity as a treatment for malignant glioma is currently a controversial topic among neurosurgeons. Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM).
  
  
  METHODS
  We searched the PubMed and Web of Science databases without any restrictions on language using the keywords "Gliadel wafers", "carmustine wafers", "BCNU wafers", or "interstitial chemotherapy" in newly diagnosed GBM for the period from January 1990 to March 2015. Randomized controlled trials (RCTs) and cohort studies/clinical trials that compared treatments designed with and without carmustine wafers and which reported overall survival or hazard ratio (HR) or survival curves were included in this study. Moreover, the statistical analysis was conducted by the STATA 12.0 software.
  
  
  RESULTS
  Six studies including two RCTs and four cohort studies, enrolling a total of 513 patients (223 with and 290 without carmustine wafers), matched the selection criteria. Carmustine wafers showed a strong advantage when pooling all the included studies (HR = 0.63, 95% confidence interval (CI) = 0.49-0.81; P = 0.019). However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR = 0.51, 95% CI = 0.18-1.41; P = 0.426), while the cohort studies demonstrated a significant survival increase (HR = 0.59, 95% CI = 0.44-0.79; P < 0.0001).
  
  
  CONCLUSIONS
  Carmustine-impregnated wafers play a significant role in improving survival when used for patients with newly diagnosed GBM. More studies should be designed for newly diagnosed GBM in the future.
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
authors.forename: Wei-kang
authors.initials: WK
authors.lastname: Xing
authors.affiliation: Department of Neurosurgery, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Shao
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
authors.forename: Zhen-yu
authors.initials: ZY
authors.lastname: Qi
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002330:Carmustine / Q000008:administration & dosage* / Q000009:adverse effects; D002626:Chemistry, Pharmaceutical; D003652:Decanoic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D004304:Dosage Forms; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D011091:Polyesters / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003652:Decanoic Acids; D004304:Dosage Forms; D011091:Polyesters; C574855:carmustine, poliferprosan 20 drug combination; D002330:Carmustine
keywords: carmustine wafers; chemotherapy; drug implants; efficacy; glioblastoma; meta-analysis; prognosis; safety