title: Safety and efficacy of carmustine (BCNU) wafers for metastatic brain tumors.
abstract: BACKGROUND
  Carmustine (BCNU) wafers (Gliadel) prolongs local disease control and progression-free survival (PFS) in patients with malignant gliomas. However, in metastatic brain tumors, there is a paucity of evidence in support of its safety and efficacy. The goal of this study was to assess the safety and efficacy of Gliadel wafers in patients with metastatic brain tumors.
  
  
  METHODS
  We retrospectively reviewed the University of Washington experience with Gliadel wafers for metastatic brain tumors between 2000 and 2015.
  
  
  RESULTS
  Gliadel wafers were used in 14 patients with metastatic brain tumors during the period reviewed. There were no postoperative seizures, strokes, or hemorrhages. There was one postoperative wound infection necessitating return to the operating room. The mean time to tumor progression (n = 7) and death (n = 5) after Gliadel wafer implantation was 2.5 and 2.9 years, respectively. Age was the only variable affecting PFS in patients receiving Gliadel wafers. Patients <53 years old (n = 7) had a PFS of 0.52 years, whereas patients >53 years old (n = 7) had a PFS of 4.29 years (P = 0.02). There was no significant difference in PFS in relation to presenting Karnofsky Performance Status (P = 0.26), number of brain metastasis (P = 0.82), tumor volume (P = 0.54), prior surgery (P = 0.57), or prior radiation (P = 0.41). There were no significant differences in the mean survival in relationship to any variable including age.
  
  
  CONCLUSIONS
  BCNU wafers are a safe and a potentially efficacious adjunct to surgery and radiation for improving local disease control in metastatic brain tumors. Larger studies, however, are needed to examine overall efficacy and tumor specific efficacy.
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Chibawanye I
authors.initials: CI
authors.lastname: Ene
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Nerva
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Ariana S
authors.initials: AS
authors.lastname: Barkley
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Barber
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ko
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Silbergeld
keywords: BCNU; Gliadel; carmustine; gliomas; metastatic brain tumor; progression free survival