OBJECT: Locoregional chemotherapy with carmustine wafers, positioned at surgery 
and followed by radiation therapy, has been shown to prolong survival in 
patients with newly diagnosed glioblastoma, as has concomitant radiochemotherapy 
with temozolomide. A combination of carmustine wafers with the Stupp treatment 
regimen has only been investigated in retrospective studies.
METHODS: In a single-institution prospective study, the authors assessed 
12-month progression-free survival (PFS), toxicity, and overall survival in 
patients with glioblastoma treated with surgery, carmustine wafers, 
radiotherapy, and 6-month metronomic temozolomide chemotherapy. Thirty-five 
patients with de novo glioblastoma, between the ages of 18 and 70 years, and 
with Karnofsky Performance Scale scores of at least 70, were included in the 
study. Patients were followed monthly and assessed using MRI every 2 months.
RESULTS: After a median follow-up of 15 months, the median time to tumor 
progression was 12.5 months and median survival was 17.8 months. Due to toxicity 
(mostly hematological), 7 patients had to prematurely stop temozolomide 
treatment. Twenty-two patients developed Grade 3 CD4(+) lymphocytopenia. Three 
patients developed oral-esophageal candidiasis, 2 developed pneumonia, and 1 
developed a dorsolumbar zoster. Early intracranial hypertension was observed in 
1 patient, and 1 was treated empirically for suspected brain abscess. One 
patient died of Legionella pneumonia soon after repeat surgery.
CONCLUSIONS: Overall, this treatment schedule produced promising results in 
terms of PFS without a marked increase in toxicities as compared with the Stupp 
regimen. However, the gain in median survival using this schedule was less 
clear. Only prospective comparative trials will determine whether these 
preliminary results will translate into a long-term survival advantage with an 
acceptable toxicity profile.