title: Rapid regression of glioblastoma following carmustine wafer implantation: A case report.
abstract: Carmustine wafers, which are locally delivered chemotherapy in the form of biodegradable implants, confer a survival benefit to patients with glioblastoma (GB) following surgical resection. While the adverse events of this method, including gas retention and perifocal edema, have been extensively investigated, the immediate efficacy of the implant has rarely been reported. To the best of our knowledge, this is the first reported case of GB in which the tumor rapidly regressed after partial surgical removal followed by implantation of carmustine wafers. A 77-year-old woman presented with motor aphasia and right hemiparesis. Neuroimaging revealed a tumor located in the left frontal lobe of the brain. The tumor was partially removed under 5-aminolevulinic acid fluorescence guidance and 8 carmustine wafers were implanted in the resection cavity. The histopathological findings suggested the diagnosis of GB. Genetic and immunohistochemical analyses revealedO6-methylguanine-DNA methyltransferase (MGMT) gene promoter methylation and low MGMT protein expression, respectively, in the tumor cells. One month after the operation, when adjuvant temozolomide chemotherapy was planned, computed tomography and magnetic resonance imaging revealed a marked regression of the residual tumor and perifocal edema. The patient's symptoms and signs had improved. As adjuvant temozolomide without radiation was therapeutically beneficial, the tumor gradually regressed and the patient has remained progression-free for >12 months after the operation. Therefore, adjuvant local chemotherapy with carmustine wafer implants was able to induce rapid regression of GB.
authors.affiliation: Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama 641-0012, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Fukai
authors.affiliation: Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama 641-0012, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishibayashi
authors.affiliation: School of Health and Nursing Science, Wakayama Medical University, Wakayama, Wakayama 641-0011, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uematsu
authors.affiliation: Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Osaka 540-0006, Japan.
authors.forename: Yonehiro
authors.initials: Y
authors.lastname: Kanemura
authors.affiliation: Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama 641-0012, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama 641-0012, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Nakao
keywords: O6-methylguanine-DNA methyltransferase; bis-chloroethylnitrosourea; carmustine wafer; glioblastoma; local chemotherapy