Safety profile of carmustine wafers in malignant glioma: A review of controlled trials and a decade of clinical experience

Current Medical Research and Opinion

Volumn 24, Issue 11, 2008, Pages 3239-3257

  Sabel, Michael ^a   Giese, Alf ^b  

^a HEINRICH HEINE UNIVERSITY   (Germany)

^b UNIVERSITY OF GÖTTINGEN   (Germany)

Author keywords

Adverse events; BCNU wafer; Carmustine wafer; Implant; Malignant glioma; Polymer; Safety profile

Indexed keywords

CARBAMAZEPINE; CARMUSTINE; CEFOTIAM; CLINDAMYCIN; CORTICOSTEROID; COTRIMOXAZOLE; DAPSONE; DEXAMETHASONE; ETIRACETAM; GABAPENTIN; HEPARIN; LAMOTRIGINE; LOW MOLECULAR WEIGHT HEPARIN; MANNITOL; OXACILLIN; PHENOBARBITAL; PHENYTOIN; PIPERACILLIN; TEMOZOLOMIDE; TOPIRAMATE; VALPROIC ACID; VANCOMYCIN;

ADJUVANT THERAPY; APHASIA; BRAIN ABSCESS; BRAIN EDEMA; CANCER SURGERY; CLINICAL EVALUATION; CLINICAL PRACTICE; CLINICAL TRIAL; CONCENTRATION RESPONSE; CONVULSION; CRANIOTOMY; CYST; DEEP VEIN THROMBOSIS; DRUG DOSE ESCALATION; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG MEGADOSE; DRUG SAFETY; DRUG WITHDRAWAL; EUROPEAN AMERICAN; EXPERIENCE; GLIOBLASTOMA; HEALING IMPAIRMENT; HEMIPARESIS; HUMAN; HYDROCEPHALUS; INCIDENCE; INTRACRANIAL HYPERTENSION; LEUKOCYTOSIS; LIQUORRHEA; LOW DRUG DOSE; LUNG EMBOLISM; MENINGISM; MENINGITIS; MULTIMODALITY CANCER THERAPY; NEUTROPENIA; PANCYTOPENIA; PNEUMONIA; POSTOPERATIVE COMPLICATION; RECURRENT DISEASE; REVIEW; SEIZURE; SEPSIS; SURGICAL INFECTION; THROMBOCYTOPENIA; THROMBOEMBOLISM; TREATMENT DURATION; UNITED STATES; UNSPECIFIED SIDE EFFECT; VENOUS THROMBOEMBOLISM; VISUAL FIELD DEFECT; WOUND INFECTION;

ABSORBABLE IMPLANTS; ADMINISTRATION, TOPICAL; ALGORITHMS; ANTINEOPLASTIC AGENTS, ALKYLATING; BRAIN NEOPLASMS; CARMUSTINE; CHEMOTHERAPY, ADJUVANT; COMBINED MODALITY THERAPY; CONTROLLED CLINICAL TRIALS AS TOPIC; DRUG IMPLANTS; DRUG TOXICITY; GLIOMA; HUMANS; TIME FACTORS;

EID: 67649344174     PISSN: 03007995     EISSN: 14734877     Source Type: Journal    
DOI: 10.1185/03007990802508180     Document Type: Review

References (116)

1. Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002;359(9311):1011-1018
2. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352(10):987-996 (Pubitemid 40349501)
3. Giese A, Westphal M. Glioma invasion in the central nervous system. Neurosurgery 1996;39(2):235-250 (Pubitemid 26251544)
4. Giese A, Bjerkvig R, Berens ME, et al. Cost of migration: invasion of malignant gliomas and implications for treatment. J Clin Oncol 2003;21(8):1624-1636 (Pubitemid 46594118)
5. Gliadel® Wafer [prescribing information]. MGI PHARMA, Bloomington, MN, USA, 2006
6. Gliadel® Wafer [summary of product characteristics]. West Sussex, UK, 2006
7. Temodar® [prescribing information]. Schering Corp, Kenilworth, NJ, 2005
8. Sampath P, Brem H. Implantable slow-release chemotherapeutic polymers for the treatment of malignant brain tumors. Cancer Control 1998;5(2):130-137 (Pubitemid 28178234)
9. Fleming AB, Saltzman WM. Pharmacokinetics of the carmustine implant. Clin Pharmacokinet 2002;41(6):403-419 (Pubitemid 34753678)
10. Brem H, Piantadosi S, Burger PC, et al. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet 1995;345(8956):1008-1012
11. Westphal M, Hilt DC, Bortey E, et al. A Phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro-Oncology 2003;5(2):79-88 (Pubitemid 36422560)
12. Westphal M, Ram Z, Riddle V, et al. Gliadel wafer in initial surgery for malignant glioma: long-term follow-up of a multicenter controlled trial. Acta Neurochir (Wien) 2006;148(3):269-275 (Pubitemid 43341024)
13. Fung LK, Ewend MG, Sills A, et al. Pharmacokinetics of interstitial delivery of carmustine, 4-hydroperoxycyclophosphamide, and paclitaxel from a biodegradable polymer implant in the monkey brain. Cancer Res 1998;58(4):672-684 (Pubitemid 28099477)
14. Giese A, Kucinski T, Knopp U, et al. Pattern of recurrence following local chemotherapy with biodegradable carmustine (BCNU) implants in patients with glioblastoma. J Neurooncol 2004;66(3):351-360 (Pubitemid 38258351)
15. MGI PHARMA. Gliadel Wafer: Heath Care Professionals. Available at: http://www.gliadel.com/hcp/default.aspx [Last accessed 21 February 2008]
16. Rabadan AT, Hernandez D, Eleta M, et al. Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 2007;68(4):412-420 (Pubitemid 47464459)
17. McGovern PC, Lautenbach E, Brennan PJ, et al. Risk factors for postcraniotomy surgical site infection after 1,3-bis(2-chloroethyl)-1- nitrosourea (Gliadel) wafer placement. Clin Infect Dis 2003;36(6):759-765 (Pubitemid 36337980)
18. Chopko BW, Park N, Golden GA, et al. PROLONG (Prospective Look at Outcomes Nationally with GLIADEL): interim report on the malignant glioma experience. Abstract presented at the Annual Meeting of the American Association of Neurological Surgeons, 2004
19. Asher AL. Prospective analysis of temozolomide as adjuvant to Gliadel and radiation in newly diagnosed malignant glioma. Abstract presented at the Annual Meeting of the American Association of Neurological Surgeons, Washington, DC, 2007
20. Carmona DMM, Cantamessa CF, García-Salazar MM, et al. Nuevas perspectivas en el tratamiento paliativo del glioblastoma multiforme y astrocitoma anaplásico recidivado con implantes de carmustina. Oncología 2005;28(5):249-257
21. Dal Pan G, Butler L, Schactman M. Preliminary analysis of the GLIADEL treatment protocol. Abstract presented at the ASCO Annual Meeting, Atlanta, GA, 1997
22. Darakchiev BJ, Albright RE, Breneman JC, et al. Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme. J Neurosurg 2008;108(2):236-242 (Pubitemid 351213285)
23. Eiras-Ajuria J, Rivero-Celada D, Alberdi-Viñas J, et al. A novel approach for treating deep-seated high-grade gliomas (HGG): resection and sealed-cavity implantation of carmustine (BCNU) wafer with minimally invasive surgery (MIS). Poster and abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Chicago, IL, 2006
24. González Vidal D. The safety of Gliadel® implants during the indication period in recurrent surgery in the treatment of Glioblastoma Multiforme (April 2003 - April 2005) [abstract]. Neurocirugía 2006;17(2 Suppl 1):77-78
25. Gururangan S, Cokgor L, Rich JN, et al. Phase I study of Gliadel wafers plus temozolomide in adults with recurrent supratentorial high-grade gliomas. Neuro-Oncology 2001;3(4):246-250 (Pubitemid 33674145)
26. Heery CR, Desjardins A, Quinn JA, et al. Acute toxicity analysis of patients receiving surgery, Gliadel wafer implantation, and postoperative daily temozolomide with radiation therapy for primary high-grade glioma [abstract]. J Clin Oncol 2006; 24(18S):11504
27. Kleinberg LR, Weingart J, Burger P, et al. Clinical course and pathologic findings after Gliadel and radiotherapy for newly diagnosed malignant glioma: implications for patient management. Cancer Invest 2004;22(1):1-9 (Pubitemid 38523954)
28. LaRocca R, Glisson S, Hargis J, et al. High-grade glioma treated with surgery; carmustine wafer; postoperative radiation; and procarbazine, lomustine, and vincristine chemotherapy. Neurosurg Quart 2005;15(3):167-171 (Pubitemid 41279345)
29. Licastro GM, Tonnarelli GP. Use of Gliadel wafers in glioblastom multiforma: our experience. Rivista Medica 2007; 13(4):111-118
30. Pan E, Mitchell SB, Tsai JS. A retrospective study of the safety of BCNU wafers with concurrent temozolomide and radiotherapy and adjuvant temozolomide for newly diagnosed glioblastoma patients. J Neuro-oncol 2008;88(3):353-357
31. Quinn JA, Vredenburgh JJ, Rich JN, et al. Phase II trial of Gliadel plus O6-benzylguanic (O6-BG) for patients with recurrent glioblastoma multiforme [abstract]. J Clin Oncol 2007; 25(18S):2036 (Pubitemid 46543491)
32. Sampath P, Sungarian A, Alderson L., et al. BCNU-impregnated wafers (Gliadel) plus irinotecan (Camptosar) in combination treatment for patients with recurrent glioblastoma multiforme. Poster and abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Boston, MA, 2005
33. Sampath P, Weaver CE, Alderson L, et al. Consecutive use of brachytherapy (Gliasite) and intratumoral chemotherapy (Gliadel) for recurrent glioblastoma: a Phase I/II study with independent clinical review. Poster and abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Boston, MA, 2005
34. Tait MJ, Critchley GR. Experience of revision craniotomy for debulking of high grade gliomas in 27 patients in a single UK centre, with and without insertion of carmustine wafers. Meeting of the Society of British Neurosurgeons, Preston, UK, 2006
35. Tozer K, Silbergeld DL, Rostomily RC, et al. Concomitant use of Gliadel and permanent low-activity I-125 seed implants for recurrent malignant glioma. abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Denver, CO, 2003
36. Uff CEG, Bradford R. Use of Gliadel (BCNU) Wafers in high grade glioma. Abstract presented at the meeting of the Society of British Neurosurgeons, Plymouth, UK, 2005
37. Weingart J, Grossman SA, Carson KA, et al. Phase I trial of polifeprosan 20 with carmustine implant plus continuous infusion of intravenous O6-benzylguanine in adults with recurrent malignant glioma: new approaches to brain tumor therapy CNS consortium trial. J Clin Oncol 2007;25(4):399-404 (Pubitemid 350002988)
38. Zamorano L, Li Q, Levin K., et al. Brachytherapy with I-125 permanent implant combined with sequential Gliadel in the treatment of patients with GBM. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Boston, MA, 2005
39. Blandini G, Barone F, Ventara F. Adjuvant treatment of high-grade gliomas with Gliadel: preliminary experience. Rivista Medica 2007;13(4):131-133
40. Kalra R, Zahner M, Nicoletti LK, et al. Retrospective analysis of the clinical usage of the chemotherapy agent Gliadel wafer in patients with malignant gliomas. Neuro-Oncology 2006;4:444
41. Subach BR, Witham TF, Kondziolka D, et al. Morbidity and survival after 1,3-bis(2-chloroethyl)-1-nitrosourea wafer implantation for recurrent glioblastoma: a retrospective case-matched cohort series. Neurosurgery 1999;45(1):17-22 (Pubitemid 29318869)
42. LaRocca RV, Hodes J, Villanueva WG, et al. A Phase II study of radiation with concomitant and then sequential temozolomide (TMZ) in patients with newly diagnosed supratentorial high-grade malignant glioma who have undergone surgery with carmustine (BCNU) wafer insertion [abstract]. Abstract presented at the Annual Meeting of the Society of Neuro-oncology, Orlando, FL, 2006
43. Zeltzer PM, Black KL, Adamson P, et al. A Phase 1/2 feasibility trial of surgery, Gliadel® Wafer and neoadjuvant continuous infusion vincristine (CIV) for patients with recurrent or progressive anaplastic astrocytoma or glioblastoma multiforme [abstract]. Neuro-Oncology 2002;4(4):241-395
44. Valtonen S, Timonen U, Toivanen P, et al. Interstitial chemotherapy with carmustine-loaded polymers for high-grade gliomas: a randomized double-blind study. Neurosurgery 1997;41(1):44-8; discussion 8-9 (Pubitemid 27282080)
45. Afra D, Norman D, Levin VA. Cysts in malignant gliomas. Identification by computerized tomography. J Neurosurg 1980;53(6):821-825 (Pubitemid 11194444)
46. Bohinski RJ, Kokkino AK, Warnick RE, et al. Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 2001;48(4):731-742 (Pubitemid 32268082)
47. Brandes AA, Scelzi E, Salmistraro G, et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer 1997;33(10):1592-1596 (Pubitemid 28123480)
48. Brell M, Ibanez J, Caral L, et al. Factors influencing surgical complications of intra-axial brain tumours. Acta Neurochir (Wien) 2000;142(7):739-750 (Pubitemid 30450053)
49. Cabantog AM, Bernstein M. Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci 1994;21(3):213-218 (Pubitemid 24276130)
50. Chang SM, Parney IF, McDermott M, et al. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 2003;98(6):1175-1181 (Pubitemid 36617917)
51. Constantini S, Cotev S, Rappaport ZH, et al. Intracranial pressure monitoring after elective intracranial surgery. A retrospective study of 514 consecutive patients. J Neurosurg 1988; 69(4):540-544 (Pubitemid 18241665)
52. Dhami MS, Bona RD, Calogero JA, et al. Venous thromboembolism and high grade gliomas. Thromb Haemostasis 1993; 70(3):393-396 (Pubitemid 23254663)
53. Fadul C, Wood J, Thaler H, et al. Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 1988;38(9):1374-1379 (Pubitemid 18217460)
54. Hase U, Reulen HJ, Schubert R, et al. The course of intracranial pressure and volume-pressure relationships following extirpation of meningiomas and astrocytomas. Acta Neurochir (Wien) 1978;44(3-4):161-171 (Pubitemid 9088757)
55. Rasmussen M, Bundgaard H, Cold GE. Craniotomy for supratentorial brain tumors: risk factors for brain swelling after opening the dura mater. J Neurosurg 2004;101(4):621-626 (Pubitemid 43186420)
56. Ruff RL, Posner JB. Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 1983; 13(3):334-336
57. Sawaya R, Zuccarello M, Elkalliny M, et al. Postoperative venous thromboembolism and brain tumors: part I. Clinical profile. J Neuro-oncol 1992;14(2):119-125
58. Sawaya R, Hammoud M, Schoppa D, et al. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 1998;42(5):1044-1055 (Pubitemid 28196516)
59. Tandon PN, Mahapatra AK, Khosla A. Epileptic seizures in supratentorial gliomas. Neurol India 2001;49(1):55-59 (Pubitemid 32385275)
60. Taylor MD, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 1999;90(1):35-41 (Pubitemid 29024737)
61. Tenney JH, Vlahov D, Salcman M, et al. Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis. J Neurosurg 1985; 62(2):243-247 (Pubitemid 15159953)
62. Volc D, Jellinger K, Flament H, et al. Cerebral space-occupying cysts following radiation and chemotherapy of malignant gliomas. Acta Neurochir (Wien) 1981;57(3-4):177-193 (Pubitemid 11006135)
63. Oertel J, von Buttlar E, Schroeder HW, et al. Prognosis of gliomas in the 1970s and today. Neurosurg Focus 2005;18(4):e12
64. Tamargo RJ, Epstein JI, Reinhard CS, et al. Brain biocompatibility of a biodegradable, controlled-release polymer in rats. J Biomed Mater Res 1989;23(2):253-266 (Pubitemid 19042070)
65. Semrad TJ, O'Donnell R, Wun T, et al. Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 2007;106(4):601-608 (Pubitemid 46536455)
66. Marras LC, Geerts WH, Perry JR. The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 2000; 89(4):640-646 (Pubitemid 30640111)
67. Eiras-Ajuria J, Rivero-Celada D, Alberdi-Viñas J, et al. Minimally invasive craniotomy to apply carmustine wafers in a tight cavity to improve safety and efficacy in malignant gliomas. Abstract presented at the Congress of the European Association of Neurooncology, Vienna, Austria, 2006
68. Vorster SJ, H. BG. A proposed preoperative grading scheme to assess risk for surgical resection of primary and secondary intraaxial supratentorial brain tumors. Neurosurg Focus 1998;4(6):e2
69. Kole M, Rock J. Malignant Glioma Surgery: Complication Avoidance. Neurosurg Quart 2002;12(3):251-258
70. Prestwich RJ, Sivapalasunrtharam A, Johnston C, et al. Survival in high-grade glioma: a study of survival in patients unfit for or declining radiotherapy. Clin Oncol (R Coll Radiol) 2005; 17(3):133-137 (Pubitemid 40468477)
71. Toms SA, Ferson DZ, Sawaya R. Basic surgical techniques in the resection of malignant gliomas. J Neuro-oncol 1999; 42(3):215-226 (Pubitemid 29322198)
72. Lawson HC, Sampath P, Bohan E, et al. Interstitial chemotherapy for malignant gliomas: the Johns Hopkins experience. J Neuro-oncol 2007;83(1):61-70 (Pubitemid 46647166)
73. Final appraisal determination - carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma. National Institute for Health and Clinical Excellence, 2007. Available at: http://www.nice.org.uk/ nicemedia/pdf/Glioma-carmustine-FAD.pdf [Last accessed 6 May 2008]
74. Clinical Practice Guidelines in Oncology. Central Nervous System Cancers, edition v.1.2008. National Comprehensive Cancer Network, 2008. Available at: http://www.nccn.org/professionals/physician-gls/PDF/cns.pdf [Last accessed 5 May 2008]
75. Stummer W, Pichlmeier U, Meinel T, et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre Phase III trial. Lancet Oncol 2006;7(5):392-401
76. Golden GA, Meldorf M, PROLONG Study Group. Number of wafers used in a cohort of 322 patients implanted with Gliadel Wafer [abstract]. Neuro-Oncology 2004;6(4):307-400
77. Krzeminski JP, Meldorf MG, Agarwal S. Repeated implantation of the Gliadel Wafer to treat malignant gliomas. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Denver, CO, 2003
78. Ewend MG. Polymer-based local therapy. 2007. Available at: http://www.gliomaed.com/topic-detail.asp?id=10 [Last accessed 22 May 2008]
79. Thompson RC, Motwani SB, Riedinger MS, et al. Clinical variables associated with development of communicating hydrocephalus following resection of astrocytoma. Abstract presented at the Annual Meeting of the American Association of Neurological Surgeons, Chicago, IL, 2002
80. Chopko B, Golden GA, Meldorf M. PROLONG® (Prospective Look at Outcomes Nationally with GLIADEL®): report on patient care practices with GLIADEL® implantation in brain cancer. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, San Francisco, CA, 2004
81. Korinek AM, Golmard JL, Elcheick A, et al. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 2005;19(2):155-162 (Pubitemid 41284762)
82. Fung LK, Shin M, Tyler B, et al. Chemotherapeutic drugs released from polymers: distribution of 1,3-bis(2-chloroethyl)-1-nitrosourea in the rat brain. Pharm Res 1996;13(5):671-682 (Pubitemid 26156217)
83. Engelhard HH. The role of interstitial BCNU chemotherapy in the treatment of malignant glioma. Surg Neurol 2000; 53(5):458-464 (Pubitemid 30386896)
84. MGI PHARMA. How to Use GLIADEL® Wafer. 2007. Available at: http://www.gliadel.com/hcp/about/how.aspx [Last accessed 6 May 2008]
85. Bertin ML, Mani A, Barnett G, et al. Risk factors for surgical site infection after 1,3-bis(2-chlorethyl)-1-nitrosurea (BCNU) Gliadel Wafer implatation for glioblastoma [abstrac]. Infect Control Hosp Epidemiol 2000;21(2):144
86. Jones NS, Becker DG. Advances in the management of CSF leaks. BMJ 2001;322(7279):122-123
87. Gottfried ON, Deogaonkar M, Way DL, et al. Postoperative cerebral edema after intracavitary implantation of Gliadel(R) wafers for treatment of malignant gliomas [abstract]. J Invest Med 2000;48(1):79
88. Weber EL, Goebel EA. Cerebral edema associated with Gliadel wafers: two case studies. Neuro-Oncology 2005; 7(1):84-89 (Pubitemid 40310196)
89. Highsmith JM, Broaddus WC. Reduction of Complications with Carmustine Wafers. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Boston, MA, 2005
90. Brem H, Mahaley MS, Jr, Vick NA, et al. Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas. J Neurosurg 1991;74(3):441-446
91. Management of peritumoral edema. European Association of Neurooncology, 2003. Available at: http://www.eano.eu/documents/guidelines/Management-of- Peritumoural-Edema.pdf [Last accessed 6 May 2008]
92. Raslan A, Bhardwaj A. Medical management of cerebral edema. Neurosurg Focus 2007;22:E12
93. Chang SM, Parney IF, Huang W, et al. Patterns of care for adults with newly diagnosed malignant glioma. JAMA 2005; 293(5):557-564 (Pubitemid 40171237)
94. Sirven JI, Wingerchuk DM, Drazkowski JF, et al. Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 2004;79(12):1489- 1494 (Pubitemid 39578871)
95. Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;54(10):1886-1893
96. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007;6(5):421-430 (Pubitemid 46551867)
97. Hughes MA, Parisi M, Grossman S, et al. Primary brain tumors treated with steroids and radiotherapy: low CD4 counts and risk of infection. Int J Radiat Oncol Biol Phys 2005;62(5):1423-1426 (Pubitemid 40982064)
98. Barker F. Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis. Neurosurgery 1994;35:484-492 (Pubitemid 24275772)
99. Barker FG 2nd. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007;60(5):887-94; discussion 94
100. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(3 Suppl):338S-400S (Pubitemid 39302602)
101. Engelhard HH, Maher de Leon ME, Rozental JM. Tumor bed cyst formation after BCNU wafer implantation. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Seattle, WA, 1998
102. McGirt MJ, Villavicencio AT, Bulsara KR, et al. Management of tumor bed cysts after chemotherapeutic wafer implantation. Report of four cases. J Neurosurg 2002; 96(5):941-945 (Pubitemid 34415410)
103. Sampath R, Brem S, Wotoczek-Obadia M, et al. MR findings to differentiate physiological responses from neoplastic progression or brain abscess in patients with brain tumors treated with implantable chemotherapeutic-wafers. Poster and abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Chicago, IL 2006
104. de Wit MC, de Bruin HG, Eijkenboom W, et al. Immediate post-radiotherapy changes in malignant glioma can mimic tumor progression. Neurology 2004;63(3):535-537 (Pubitemid 39031388)
105. Chamberlain MC, Glantz MJ, Chalmers L, et al. Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastoma. J Neuro-oncol 2007;82(1):81-83 (Pubitemid 46252277)
106. Hammoud DA, Belden CJ, Ho AC, et al. The surgical bed after BCNU polymer wafer placement for recurrent glioma: serial assessment on CT and MR imaging. Am J Roentgenol 2003; 180(5):1469-1475 (Pubitemid 36504646)
107. Khan AK, Tobias M, Sungarian A, et al. Post-operative pneumocephalus following carmustine polymer placement mimicking intracranial infection: report of four cases. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, San Antonio, TX, 2000
108. Prager JM, Grenier Y, Cozzens JW, et al. Serial CT and MR imaging of carmustine wafers. Am J Neuroradiol 2000; 21(1):119-123 (Pubitemid 30225837)
109. Deogaonkar M, Way D, Gottfried O, et al. Persistent intracranial air and increased postoperative vasogenic edema after intracavitatory implantation of Gliadel wafers for malignant gliomas. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Boston, MA, 1999
110. Smith KA, Ashby L, Gonzolas F. Gross total resection (GTR) with Gliadel® Wafer implantation followed by post-operative gamma knifetm radiosurgery and adjuvant fractionated radiotherapy for newly diagnosed GBM: Phase I/II study of safety and efficacy in 30 consecutive patients. Abstract presented at the Annual Meeting of the Congress of Neurological Surgeons, Chicago, IL, 2006
111. Limentani SA, Asher A, Heafner M, et al. A Phase I trial of surgery, Gliadel wafer implantation, and immediate postoperative carboplatin in combination with radiation therapy for primary anaplastic astrocytoma or glioblastoma multiforme. J Neuro-oncol 2005;72(3):241-244 (Pubitemid 40867407)
112. Lawson DH, Phuphanich S, McKenzie E, et al. Phase I analysis of systemic interferon alpha utilized with gliadel in adults with recurrent glioblastoma multiforme (GBM). Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I Vol24, No 18S (June 20 Supplement), 2006: 11508
113. Spiegel BM, Esrailian E, Laine L, et al. Clinical impact of adjuvant chemotherapy in glioblastoma multiforme: a meta-analysis. CNS Drugs 2007;21(9):775-787 (Pubitemid 47294722)
114. Ashby LS, Ryken TC. Management of malignant glioma: steady progress with multimodal approaches. Neurosurg Focus 2006;20(4):E3
115. Wen PY, Kesari S. Malignant gliomas in adults. New Engl J Med 2008;359(5):492-507
116. Lesniak MS, Brem H. Targeted therapy for brain tumours. Nat Rev Drug Discov 2004;3(6):499-508 (Pubitemid 38807532)