BACKGROUND: The study investigated if intraoperative use of carmustine wafers, 
particularly in combination with Stupp regimen, is a viable and safe first-line 
treatment option of glioblastomas.
METHODS: Eighty-three consecutive adult patients (50 men; mean age 60 years) 
with newly diagnosed supratentorial primary glioblastomas that underwent 
surgical resection with intraoperative carmustine wafers implantation (n = 7.1 ± 
1.7) were retrospectively studied.
RESULTS: The median overall survival (OS) was 15.8 months with 56 patients dying 
over the course of the study. There was no significant association between the 
number of implanted carmustine wafers and complication rates (four surgical site 
infections, one death). The OS was significantly longer in Stupp regimen 
patients (19.5 months) as compared with patients with other postoperative 
treatments (13 months; p = 0.002). In addition patients with eight or more 
implanted carmustine wafers survived longer (24.5 months) than patients with 
seven or less implanted wafers (13 months; p = 0.021). Finally, regardless of 
the number of carmustine wafers, median OS was significantly longer in patients 
with a subtotal or total resection (21.5 months) than in patients with a partial 
resection (13 months; p = 0.011).
CONCLUSIONS: The intraoperative use of carmustine wafers in combination with 
Stupp regimen is a viable first-line treatment option of glioblastomas. The 
prognostic value of this treatment association should be evaluated in a 
multicenter trial, ideally in a randomized and placebo-controlled one.