Implant Combination Prolongs Survival in Glioblastoma

Survival in recurrent glioblastoma multiforme was extended without major toxicity by low-activity iodine-125 seeds and carmustine wafers (Gliadel) implanted simultaneously during brain surgery, researchers here said. Median overall survival time following treatment was 69 weeks and median progression-free survival time was 47 weeks in an uncontrolled trial involving 34 patients, reported Ronald Warnick, M.D., and colleagues at the University of Cincinnati in the February issue of the Journal of Neurosurgery. Brain necrosis was more common than the researchers expected from past experience with either brachytherapy or the chemotherapy wafers alone, Dr. Warnick and colleagues wrote. But, they said, these and other adverse effects were manageable and did not affect survival. Iodine-125 seeds were placed perpendicularly into the surrounding brain parenchyma, with numbers and spacing calculated to deliver about 120Gy to a depth of 5 mm. Four to eight carmustine wafers were also placed without overlap along the margins of the resection cavity. Because this was a dose-finding study, the first six patients received four wafers, five patients received six, three patients received seven, and 20 patients received eight. The median carmustine dose delivered to all patients was 61.6 mg. Dr. Warnick described the 69-week median survival seen in his patients as "quite remarkable when you compare it with other treatments." For example, survival with chemotherapy for recurrent glioblastoma is typically about six months, he said, and radioactive seed therapy has shown median overall survival of about 47 weeks. Primary source: Journal of Neurosurgery, Darakchiev B, et al "Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme" J Neurosurg 2008; 108. http://www.medpagetoday.com/HematologyOncology/BrainCancer/tb/8016 (accessed Jan, 19 2008).