This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ewend, M. G. Articles by Carey, L. A. Search for Related Content PubMed PubMed Citation Articles by Ewend, M. G. Articles by Carey, L. A.

Treatment of Single Brain Metastasis with Resection, Intracavity Carmustine Polymer Wafers, and Radiation Therapy Is Safe and Provides Excellent Local Control

Authors' Affiliations: ¹ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ² H. Lee Moffitt Cancer Center, Tampa, Florida; ³ M. D. Anderson Cancer Center, Houston, Texas; ⁴ University of Washington and VA Puget Sound Health Care System, Seattle, Washington; and ⁵ University of Vermont, Burlington, Vermont

Requests for reprints: Matthew G. Ewend, Division of Neurosurgery, University of North Carolina at Chapel Hill, 3013 Burnett-Womack Building, Chapel Hill, NC 27599. Phone: 919-966-1374; Fax: 919-966-6627; E-mail: ewend{at}med.unc.edu.

Purpose: To define the safety and efficacy of carmustine polymer wafers when added to a regimen of surgery and external beam radiotherapy for treatment of a single brain metastasis.

Experimental Design: Adult patients underwent craniotomy for a single brain metastasis, and carmustine polymer wafers were placed in the tumor resection cavity. Patients then received whole-brain radiotherapy and were followed for patterns of recurrence in the central nervous system, toxicity, and survival.

Results: We enrolled 25 patients with solitary brain metastases from lung (13 patients), melanoma (4 patients), breast (3 patients), and renal carcinoma (3 patients). Two patients had severe adverse events thought to be related to wafer placement, one with seizures alone, and one with seizures and subsequent respiratory compromise. Both responded to medical therapy. There were no wound infections. The local recurrence rate was surprisingly low (0%). Four patients (16%) relapsed elsewhere in the brain, and two patients (8%) relapsed in the spinal cord. Median survival was 33 weeks; 33% of patients survived 1 year, and 25% survived 2 years.

Conclusions: The addition of local chemotherapy delivered via carmustine polymer wafers to a regimen of surgical resection and external beam radiotherapy was well tolerated by patients undergoing surgery for a single brain metastasis. There were no local recurrences, suggesting that this treatment further reduced the risk of local relapse.

This article has been cited by other articles:

				F. J. Attenello, D. Mukherjee, G. Datoo, M. J. McGirt, E. Bohan, J. D. Weingart, A. Olivi, A. Quinones-Hinojosa, and H. Brem Use of Gliadel (BCNU) Wafer in the Surgical Treatment of Malignant Glioma: A 10-Year Institutional Experience Ann. Surg. Oncol., October 1, 2008; 15(10): 2887 - 2893. [Abstract] [Full Text] [PDF]