The combination of permanent iodine-125 seed implants and carmustine (BCNU) wafers is safe and effective in patients with recurrent glioblastoma multiforme (GBM), according to a report in the February issue of the
Journal of Neurosurgery."We consider the use of radiation seeds and chemotherapy wafers to be standard treatment for recurrent glioblastoma at our center," Dr. Ronald E. Warnick from University of Cincinnati, Cincinnati, Ohio told Reuters Health.
Dr. Warnick and colleagues assessed the safety and efficacy of combination adjunctive therapy with permanent, low-activity I-125 seed implants and BCNU wafers following resection in a phase I/II trial involving 34 patients with recurrent GBM.
Median survival after resection and implantation was 69 weeks, the authors report, and survival rates were 82 per cent at six months, 66 per cent at 12 months, 37 per cent at 18 months, and 23 per cent at 24 months.
Tumor recurrence occurred after a median 47 weeks, and the progression-free survival rates were 67 per cent at six months, 32 per cent at 12 months, 20 per cent at 18 months, and 13 per cent at 24 months.
A better Karnofsky performance score was associated with longer survival and progression-free survival, the investigators say, and increased I-125 dose density and lower age were associated with longer overall survival.
Brain necrosis was confirmed by positron electron tomography in eight ptients, the researchers note, but the development of necrosis did not affect survival.
"This treatment can be delivered by any neurosurgeon at nearly any hospital in the world, as opposed to complicated therapies like stem cell therapy, immunotherapy, and vaccines that are limited to just a few of the largest brain tumor centers," Dr. Warnick commented. "Patients with recurrent glioblastoma do not necessarily need to travel to one of a few major brain tumor centers for their treatment."
The results of the trial are encouraging enough that the team is moving ahead with other investigational studies, Dr. Warnick added. "We have initiated a clinical trial to test the combination of seeds and wafers in the treatment of newly diagnosed glioblastoma.
