title: Patterns of Recurrence After Resection of Malignant Gliomas With BCNU Wafer Implants: Retrospective Review in a Single Institution.
abstract: BACKGROUND
  Bis-chloroethylnitrosourea (BCNU) wafers have been demonstrated to be effective for prolonging survival for patients with malignant glioma and have been approved worldwide. BCNU wafers are implantable and have a unique feature of delivering chemotherapeutic drug at high concentration at tumor margin over time after resection. BCNU wafers presumably, by this mechanistic rationale, have a beneficial effect on local tumor control and thus could change the pattern of recurrence, which is most frequently local. However, no studies have demonstrated such phenomenon after BCNU wafer implants.
  
  
  METHODS
  To investigate whether the surgeries with BCNU wafers alter the predominant tendency of local recurrence pattern, we retrospectively reviewed 8 malignant glioma patients treated with BCNU wafers (BCNU wafer group), together with 22 glioma patients who did not receive BCNU wafers (no-BCNU wafer group) for comparison.
  
  
  RESULTS
  Out of 6 patients in BCNU wafer group who exhibited recurrence, 1 showed local, 2 showed diffuse, and 3 showed a distant recurrence pattern, which was away from resection cavity. On the other hand, out of 18 patients in the no-BCNU wafer group who exhibited recurrence, 10 showed a local pattern, 8 showed a diffuse pattern, and no cases showed distant pattern. Distant pattern was observed significantly more frequently in the BCNU wafer group than in the no-BCNU wafer group.
  
  
  CONCLUSIONS
  These results suggest that BCNU wafers could have a beneficial effect on local tumor control and may provide BCNU wafers with a new profile that could be considered for establishing future chemotherapeutic strategy for glioma patients.
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan. Electronic address: shinji.shimato@gmail.com.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimato
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Nishizawa
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ohshima
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Imai
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Aichi, Japan.
authors.forename: Kyozo
authors.initials: K
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D002330:Carmustine / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004343:Drug Implants; D002330:Carmustine
keywords: BCNU wafers; Glioma; Pattern; Recurrence