OBJECTIVE: The prognosis of high-grade glioma (HGG) is poor with a median 
survival of about 1 year for glioblastoma. In 2007, NICE published a technology 
appraisal (TA121) recommending the use of carmustine wafers (Gliadel) and 
systemic therapy with temozolomide for selected patients with HGG. Outcomes for 
HGG surgery in the United Kingdom with these combined treatments have not been 
published.
DESIGN: Retrospective audit of consecutive patients in a single unit with 
carmustine wafer implantation.
SUBJECTS: Fifty-nine patients had carmustine wafers implanted at primary 
surgery, between October 2005 and October 2010 at Wessex Neurological Centre, 
Southampton, UK.
METHODS: Patients were given chemotherapeutic treatments strictly according to 
NICE TA121. Survival was calculated using Kaplan-Meier method.
RESULTS: Fifty-five patients had WHO grade IV tumours and four had grade III. 
Median age was 61 years. At follow-up, 39 patients had died. Median survival was 
15.3 months. Eight patients (13.5%) experienced post-operative complications 
(including five infections) for which four had the carmustine wafers removed. 
Forty-seven (80%) patients were treated with radical radiotherapy (55-60 Gy) and 
six (10%) patients received palliative radiotherapy (30 Gy). Thirty-seven 
patients (63%) received concomitant temozolomide chemotherapy. In the subset of 
37 patients receiving multimodal treatment with radical radiotherapy and 
concomitant temozolomide, median survival was 15.8 months compared with 7.4 
months in those not receiving multimodal treatment.
DISCUSSION: Carmustine wafers for primary HGG surgery in accordance with the 
NICE TA121 were associated with a median survival of 15.3 months; this is 
improved compared with previously reported randomised trials. Multimodal 
treatment with carmustine wafers, radical radiotherapy and concomitant 
temozolomide was associated with improved survival. Increased incidence of 
infections was observed in cases receiving carmustine wafers.