High-Grade Glioma Treated With Surgery; Carmustine Wafer; Postoperative Radiation; and Procarbazine, Lomustine, and Vincristine Chemotherapy:

From 1999 through October 2001, 9 patients were enrolled in an institutional review board-approved, phase I/II, community-based study evaluating carmustine (BCNU) wafer insertion at initial surgery in patients with high-grade glioma. Patients received postoperative limited-field radiation therapy (RT), followed by standard procarbazine, lomustine, and vincristine (PCV) chemotherapy. The average age of the patients was 55 years. Seven patients had a final histologic diagnosis of glioblastoma multiforme (GBM), 1 had anaplastic astrocytoma (AA), and 1 had anaplastic oligodendroglioma (AO). Each patient had 5 to 8 BCNU wafers inserted. Eight patients completed RT, but only 4 completed more than 1 cycle of PCV One patient developed a cranial wound infection requiring reoperation, removal, and reinsertion of wafers. A second developed a sterile abscess at the operative site subsequent to completion of RT and 1 cycle of PCV The abscess was removed surgically. One patient experienced a nonfatal pulmonary embolus during RT. The median survival of the 9 patients from the time of initial craniotomy was 17+ months (15 months for the 7 patients with GBM), and 3 patients are still alive at 34, 35, and 46 months (2 with GBM and 1 with AA). One resides with family, and 2 remain independently functional. We conclude that treatment with BCNU wafer insertion at initial surgery, followed by RT and PCV, is feasible without apparent excessive treatment-related toxicity. Although this study is small, it is noteworthy that at study close in February 2004, 3 patients (2 with GBM) in this cohort were alive 34 to 46 months after initial treatment.