PMID- 18240917
OWN - NLM
STAT- MEDLINE
DCOM- 20080328
LR  - 20220330
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 108
IP  - 2
DP  - 2008 Feb
TI  - Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers 
      in patients with recurrent glioblastoma multiforme.
PG  - 236-42
LID - 10.3171/JNS/2008/108/2/0236 [doi]
AB  - OBJECT: Effective treatment options are limited for patients with recurrent 
      glioblastoma multiforme (GBM), and survival is usually <1 year. Novel treatment 
      approaches are needed. Localized adjunct treatment with carmustine (BCNU) wafers 
      or permanent, low-activity 125I seed implants has been shown to be effective for 
      GBM. This study assessed the efficacy and safety of these therapies in 
      combination following tumor resection. METHODS: Thirty-four patients with 
      recurrent GBM were treated with maximal tumor resection followed by implantation 
      of BCNU wafers and permanent 125I seeds into the tumor cavity. Patients were 
      followed up with clinical evaluations and magnetic resonance imaging studies once 
      every 3 months. Survival and progression-free survival (PFS) were evaluated. 
      RESULTS: During follow-up, local disease progression was observed in 27 patients, 
      and 23 of them died. The median survival period was 69 weeks, and the median PFS 
      was 47 weeks. The 12-month survival and PFS rates were 66 and 32%, respectively. 
      Baseline factors associated with prolonged survival included Karnofsky 
      Performance Scale score>or=70, 125I seed activity>or=0.8 mCi/cm3 of tumor cavity, 
      and age<60 years. Brain necrosis developed in 8 patients (24%) and was 
      successfully treated with surgery or hyperbaric oxygen therapy. CONCLUSIONS: The 
      use of adjunct therapy combining BCNU wafers and permanent 125I seeds resulted in 
      survival that compares favorably with data from similar studies performed in 
      patients with recurrent GBM. The incidence of brain necrosis appeared to be 
      higher than that expected with either treatment alone, although the necrosis was 
      manageable and did not affect survival. This novel approach warrants further 
      investigation in recurrent and newly diagnosed GBM.
FAU - Darakchiev, Borimir J
AU  - Darakchiev BJ
AD  - Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati 
      Medical Center, Cincinnati, Ohio 45267-0515, USA.
FAU - Albright, Robert E
AU  - Albright RE
FAU - Breneman, John C
AU  - Breneman JC
FAU - Warnick, Ronald E
AU  - Warnick RE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - 0 (Antineoplastic Agents, Alkylating)
RN  - 0 (Drug Implants)
RN  - 0 (Iodine Radioisotopes)
RN  - 0 (Radiopharmaceuticals)
RN  - U68WG3173Y (Carmustine)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Antineoplastic Agents, Alkylating/*administration & dosage
MH  - Brachytherapy/*instrumentation
MH  - Brain/pathology
MH  - Brain Neoplasms/*surgery
MH  - Carmustine/*administration & dosage
MH  - Disease Progression
MH  - Disease-Free Survival
MH  - Drug Implants
MH  - Female
MH  - Follow-Up Studies
MH  - Glioblastoma/*surgery
MH  - Humans
MH  - Hyperbaric Oxygenation
MH  - Iodine Radioisotopes/*therapeutic use
MH  - Karnofsky Performance Status
MH  - Male
MH  - Middle Aged
MH  - Necrosis
MH  - *Neoadjuvant Therapy
MH  - Neoplasm Recurrence, Local/*surgery
MH  - Radiopharmaceuticals/*therapeutic use
MH  - Safety
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2008/02/05 09:00
MHDA- 2008/03/29 09:00
CRDT- 2008/02/05 09:00
PHST- 2008/02/05 09:00 [pubmed]
PHST- 2008/03/29 09:00 [medline]
PHST- 2008/02/05 09:00 [entrez]
AID - 10.3171/JNS/2008/108/2/0236 [doi]
PST - ppublish
SO  - J Neurosurg. 2008 Feb;108(2):236-42. doi: 10.3171/JNS/2008/108/2/0236.