This Cochrane review assessed whether chemotherapeutic wafers have any advantage over conventional therapy for high grade glioma (HGG). Outcome measures included survival, time to progression, quality of life (QOL) and adverse events. In primary disease two RCTs assessing the effect of carmustine impregnated wafers (Gliadel®) and enrolling a total of 272 participants were identified. Survival was increased (hazard ratio (HR) 0.65 confidence interval (CI) 0.48 to 0.86 p = 0.003). In recurrent disease a single RCT was included assessing the effect of Gliadel® and enrolling 222 participants. It did not demonstrate a significant survival increase (HR 0.83 CI 0.62 to 1.10 p = 0.2). There was no suitable data for time to progression or QOL. Adverse events were not more common in either arm, and were presented in a descriptive fashion.

The reviewers conclude that Gliadel® results in a prolongation of survival without an increased incidence of adverse events when used as primary therapy. There is no evidence of enhanced progression free survival (PFS) or QOL. In recurrent disease, Gliadel® does not appear to confer any added benefit. These findings are based on the results of three RCTs with approximately 500 patients in total.

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