Localized Chemotherapy with Carmustine (BCNU) Wafers in High-Grade Gliomas: Clinical Outcomes and Safety Review

Gliadel wafers are biodegradable polymers, impregnated with the chemotherapeutic drug carmustine, also known as 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). These wafers are surgically implanted in order to provide localized chemotherapy to malignant brain tumors. While Gliadel wafers have been used for many years, their positive impacts and adverse effects are still under investigation. This study aims to evaluate the efficacy and safety of these wafers through a review of recent literature. This was conducted using PubMed and Google Scholar, focusing on studies published after 1995. Data were extracted from 14 different sources, including randomized controlled trials (RCTs), cohort studies, and meta-analyses. Each source included study design, sample size, survival outcomes, and reported adverse effects. Studies published prior to 1995, as well as editorials, and case reports, were excluded. Across many included studies, the Gliadel wafer implantation was associated with trends toward improved overall survival (OS). Adverse effects were generally similar to the ones found in localized chemotherapy. Overall, the findings conclude that BCNU wafers may serve as an able adjunct to traditional chemotherapeutic methods.