Letters to the Editor
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Chemotherapy Wafers (Gliadel) in the Treatment of Malignant Brain Tumours
The Clinical Neuroscience Society held an Extraordinary General Meeting on 25 March 1998 and decided that a controversy has been created because of public misperception about the efficacy of Gliadel. In a letter addressed to the President of the SMA, Dr Adrian Tan, Honorary Secretary of the Clinical Neuroscience Society said that the Society has adopted a position statement for dissemination to the medical community. The Position Statement is published in full here.
Reports on this treatment can be found in the Lianhe Zaobao (18 Feb 1998) and Lianhe Wanbao (17 Feb 1998).Position Statement Clinical Neuroscience Society Position Statement on Carmustine Wafer (Gliadel) Treatment for Malignant Brain Tumours.
Gliadel is not a miracle cure for the treatment of malignant (cancerous) brain tumours. It has been approved in the USA by the FDA in September 1996 only for the treatment of recurrent glioblastomas. Three trials have been published. In one of them, there were 222 patients with recurrent malignant brain tumours. The median survival period of 110 patients receiving the treatment was 31 weeks compared with 23 weeks for the 112 patients who did not receive the treatment, ie. there was an improvement in length of survival period of 8 weeks(1). In patients with a specific form of brain cancer, glioblastoma, the 6-month survival period of the treated was 50% longer than the untreated, ie. 47 out of 73 treated patients survived 6 months against the 32 out of 72 of the untreated(1). It must be added, however, that 14 months later, 93% of the patients were dead. Reports on the side effects are conflicting. One report cited complications including weakness of one side of the body, convulsions, speech difficulty and defects of vision(2). A second report claims that there were no serious complications(1). The cost of treatment is approximately US$10,000 for a box of 8 wafers which have to be placed on the tumour after it is surgically exposed. The costs of surgery and hospitalisation are not included in the US$10,000. Gliadel treatment is available in all major hospitals in Singapore. We emphasise that the benefits and risks of treatment are carefully explained to the patient. The doctor should stress that treatment only prolongs life and does not cure the disease.
1. Brem H, Piantadosis S, Burger PC, Walter M, Selker R, Vick NA, et al. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent glianas. The Lancet 1995; 345:1008-1012.
2. Valtonen S, Timonen U, Toivanen P, Kalimo H, Kivipelto L, Heiskanen O, et al. Interstitial Chemotherapy with Carmustine-loaded polymers for high grade gliomas: a randomised double-blind study. Neurosurgery 1997; 41(1):44-48.