Gliadel®, followed by standard radiotherapy, is an option for selected patients with newly diagnosed malignant glioma where a near-gross total excision is possible; however, the majority of patients with malignant glioma will not be eligible for various reasons (i.e. non-resectable tumours or contact with the ventricular system). Gliadel® is also an option in patients with surgically resectable recurrent malignant gliomas.
Several studies have looked at the rlol of Gliadel in treating brain metastases. Ninety-three patients with brain metastases (new and recurrent) were studied by three groups In these three studies, 66 patients received WBRT following resection and wafer placement and 27 patients in the PROLONG study received no WBRT. During the follow up, there was no local recurrence reported in 91 patients and only two neurologically related deaths. Therefore, data in these studies show that there may be a benefit for local chemotherapy with Gliadel.
Possible role of Gliadel for metastatic cancer to the brain is being studied: Exploratory Study, Evaluating the Treatment Effect of Surgery Plus GLIADEL® Wafer in Patients With Metastatic Brain Cancer, NCT00525590. Perry J, Chambers A, Spithoff K, Laperriere N, Neuro-oncology Disease Site Group. Gliadel wafers in the treatment of malignant glioma: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Aug 15. 19 p. (Evidence-based series; no. 9-7). [12 references]
Brem S, Staller A, Wotoczek-Obadia M, Robb J, Vrionis FD, Pearlman JL, et al: Interstitial chemotherapy for local control of CNS metastases. Neuro-oncol 6:370-371, 2004 (Abstract)
Ewend MG, Elbabaa S, Carey LA: Current treatment paradigms for the management of patients with brain metastases. Neurosurgery 57 (5 Suppl): S66-S77, 2005 of Neurology. Neurology 54:1886-1893, 2000 Golden GA, Meldorf M, PROLONG Study Group: Patients with metastatic brain cancer undergoing resection and Gliadel implantation experienced low local recurrence rates in the PROLONG registry. Neuro-oncol 6:375-376, 2004 (Abstract)