BACKGROUND: Patients with glioblastoma treated with BCNU wafer implantation for 
recurrence frequently receive frontline chemoradiotherapy with temozolomide as 
part of the Stupp protocol. A retrospective investigation was conducted of 
surgical complications in a cohort of these patients treated at a single 
institution.
METHODS: We searched our institutional database for patients treated between 
January 2006 and October 2012 who had recurrent glioblastoma previously treated 
with open surgery followed by the Stupp protocol and then underwent repeat 
resection with or without BCNU wafers for recurrent disease. Rates of select 
post-operative complications within 3 months of surgery were estimated.
RESULTS: We identified 95 patients with glioblastoma who underwent resection 
followed by the Stupp protocol as frontline treatment. At disease recurrence 
(first and second recurrence), 63 patients underwent repeat resection with BCNU 
wafer implantation and 32 without implantation. Generally, BCNU wafer use was 
associated with minor to moderate increases in rates of select complications 
versus non-implantation-wound healing abnormalities (14.2 vs. 6.2 %), 
cerebrospinal fluid leak (7.9 vs. 3.1 %), hydrocephalus requiring 
ventriculoperitoneal shunt (6.3 vs. 9.3 %), chemical meningitis (3.1 vs. 0 %), 
cerebral infections (3.1 vs. 0 %), cyst formation (3.1 vs. 3.1 %), cerebral 
edema (4.7 vs. 0 %), and empyema formations (1.5 vs. 0 %). Performance status 
was well maintained post-operatively in both groups. Median progression-free 
survival from the time of first recurrence was 6.0 and 5.0 months, respectively.
CONCLUSIONS: The use of the Stupp protocol as frontline therapy in patients with 
glioblastoma does not preclude the use of BCNU wafers at the time of 
progression.