The prognostic role of O(6)-methylguanine-DNA methyltransferase (MGMT) promoter 
methylation in glioblastoma patients treated with carmustine (BCNU) wafer 
implantation is unclear. Here, we report on a retrospective study of 47 patients 
with either newly diagnosed (30 patients) or recurrent (17 patients) 
glioblastoma (WHO grade IV) treated with BCNU (bis-chloroethylnitrosourea) 
wafers. Thirteen of the newly diagnosed patients received local BCNU and 
irradiation only (first-line BCNU), while 17 patients additionally received 
concomitant and adjuvant temozolomide (TMZ) radiochemotherapy (first-line BCNU + 
TMZ). Of the 17 patients treated for recurrent glioblastoma (second-line BCNU), 
16 had received radiotherapy with concomitant and adjuvant TMZ as an initial 
treatment. Median overall survival (OS) did not significantly differ between 19 
patients with MGMT promoter methylated tumors when compared to 28 patients with 
unmethylated tumors (18.9 vs 15.0 months; p = 0.1054). In the first-line BCNU + 
TMZ group, MGMT promoter methylation was associated with longer OS (21.0 vs 11.1 
months, p = 0.0127), while no significant survival differences were detected in 
the other two subgroups. Progression-free survival did not significantly differ 
between patients with and without MGMT promoter methylated tumors in the entire 
patient cohort or any of the three subgroups. The first-line BCNU + TMZ group 
showed no significant difference in OS when compared to the first-line BCNU 
group (18.9 vs 14.7 months), but tended to have more therapy-related adverse 
effects (53% vs 24%, p = 0.105). In summary, MGMT promoter methylation showed a 
non-significant trend toward longer survival in our patient cohort. The 
combination of TMZ radiochemotherapy with local delivery of BCNU did not provide 
a significant survival benefit compared to local BCNU alone, but was associated 
with a higher rate of adverse effects. Owing to the small number of patients 
investigated, however, these findings would need to be corroborated in larger 
patient cohorts.