Gliadel Wafers in Clinical Practice: The Neurosurgical View

European Association of NeuroOncology Magazine 2012; 2 (3): 129-132

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Keywords: adverse event,  gliadel wafer,  glioblastoma,  high-grade glioma

Gliadel wafers are the only local chemotherapeutic agent approved for the treatment of primary and recurrent malignant gliomas. Since the approval, considerable clinical experiences in multimodal regimens have been made and require a re-evaluation from a neurosurgical point of view. We reviewed the database entries from Medline, EMBASE, and BIOSIS from 2005–2012. Search terms included: gliadel, carmustine, or BCNU wafer, implant and complications or adverse events (AE). Endpoints of our analysis were efficacy and safety data of gliadel for primary and recurrent glioblastomas. AEs included intracranial infections, oedema, healing abnormalities, CSF fistulae, and hydrocephalus. For primary glioblastomas (GBM), median progression- free survival (PFS) reached 12.3 months and overall survival (OAS) ranged from 19.2– 20.7 months. For recurrences, the 6-month OAS was 82 %, 1- and 2-year OAS rates were 47 % and 10 %, respectively. Median OAS was 50.3 weeks. AE rates for primary GBMs ranged from 0.8–16.7 % for cerebral oedema, from 4.4–8.3 % for healing abnormalities, 5.5 % for liquor leaks, from 0.0–47.0 % for hydrocephalus, and 4.8 % for intracranial infection. AE rates for recurrent glioblastomas ranged from 0.0–7.2 % for cerebral oedema, from 4.8–55.6 % for healing abnormalities, from 4.8–33.3 % for CSF fistulae, from 0.6–22.2 % for hydrocephalus and 5.0 % for intracranial infection. The use of gliadel wafers is determined by the individual decision of the responsible neurosurgeon due to the absence of general guidelines. The AE rates reported in current treatment strategies are relatively low.