Implantable polymeric BCNU as an adjunct to surgery for metastatic intracranial disease

One hundred and ten cases of craniotomy for tumor utilizing BCNU implantable chemotherapy were performed by the author at the University of Iowa between (1998-2006) including 18 cases performed in 16 patients for metastatic intracranial disease. The series included 9 woman and 7 men with an average age of 56.9 years. The diagnoses were as follows: non-small lung carcinoma (9), breast cancer (3), small-cell lung cancer (1), colon cancer (1), unknown primary (2). Patients undergoing resection plus implantable chemotherapy following whole brain radiotherapy (5 patients) or following stereotactic radiosurgery (5 patients) were the most common. One patient developed local recurrence (5%). Complications included two cerebrospinal fluid leaks with associated complications requiring reoperations (11%) both following whole brain radiotherapy and 3 patients (17%) with thromboembolic episodes (3 deep venous thromboses, one with a pulmonary embolus and sudural hematoma). In this challenging population, local implantable chemotherapy appears relatively safe and a reasonable consideration as a surgical adjunct.