OBJECT: Effective treatment options are limited for patients with recurrent 
glioblastoma multiforme (GBM), and survival is usually <1 year. Novel treatment 
approaches are needed. Localized adjunct treatment with carmustine (BCNU) wafers 
or permanent, low-activity 125I seed implants has been shown to be effective for 
GBM. This study assessed the efficacy and safety of these therapies in 
combination following tumor resection.
METHODS: Thirty-four patients with recurrent GBM were treated with maximal tumor 
resection followed by implantation of BCNU wafers and permanent 125I seeds into 
the tumor cavity. Patients were followed up with clinical evaluations and 
magnetic resonance imaging studies once every 3 months. Survival and 
progression-free survival (PFS) were evaluated.
RESULTS: During follow-up, local disease progression was observed in 27 
patients, and 23 of them died. The median survival period was 69 weeks, and the 
median PFS was 47 weeks. The 12-month survival and PFS rates were 66 and 32%, 
respectively. Baseline factors associated with prolonged survival included 
Karnofsky Performance Scale score>or=70, 125I seed activity>or=0.8 mCi/cm3 of 
tumor cavity, and age<60 years. Brain necrosis developed in 8 patients (24%) and 
was successfully treated with surgery or hyperbaric oxygen therapy.
CONCLUSIONS: The use of adjunct therapy combining BCNU wafers and permanent 125I 
seeds resulted in survival that compares favorably with data from similar 
studies performed in patients with recurrent GBM. The incidence of brain 
necrosis appeared to be higher than that expected with either treatment alone, 
although the necrosis was manageable and did not affect survival. This novel 
approach warrants further investigation in recurrent and newly diagnosed GBM.