Carmustine-impregnated wafers and their impact in the management of high-grade glioma

Introduction: Carmustine-impregnated biodegradable wafers provide a locoregional adjunct to the treatment of patients with high-grade glial neoplasms. Their impact is that of delivering a chemotherapeutic agent directly to the tumor site at the time of neurosurgical intervention with a resulting increased local drug concentration and an ongoing therapeutic effect lasting several days to weeks. Areas covered: This manuscript reviews the preclinical and clinical studies that established carmustine-impregnated wafers as a locoregional therapy in the treatment of de novo as well as recurrent high-grade gliomas and compares it with other locoregional modalities currently under development. A pertinent English language literature search dating back to 1990 was undertaken. Expert opinion: Carmustine-impregnated wafers represent but one component of a multimodality armamentarium for the treatment of high-grade gliomas. The development of biodegradable compounds capable of incorporating additional therapeutic agents beyond carmustine is a subject of ongoing research. Integration of diverse treatment modalities into the management of complex high-grade cancers, taking advantage of predictive markers of efficacy, be they molecular or otherwise, will remain a major focus of clinical research in the second decade of this century.