Gliadel® implants (Carmustine)
Gliadel® implants are a new way of giving a chemotherapy drug called carmustine to people with certain types of brain tumours. This information should ideally be read with our general information about chemotherapy and your type of brain tumour.
They are mainly used to treat high-grade gliomas when surgery to remove or reduce the size of the tumour (debulking) is possible. At present, Gliadel implants aren't a standard treatment in the UK and so aren't widely available.
Although carmustine (the drug used in the implant) has been available for a long time, this is a newer way of giving it. This treatment isn't suitable for everyone with a high-grade brain tumour. At present it is licensed for people who are going to have major brain surgery. They may have just been diagnosed with a high-grade glioma or their brain tumour may have come back following previous treatment.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects.
Gliadel implants are small wafers or discs, about the size of a five pence coin, which slowly dissolve after they are placed in the brain. They contain the chemotherapy drug carmustine. As the implants dissolve, the drug is slowly released and treats tumour cells that could not be removed by surgery.
Gliadel implants are placed inside the brain during an operation to remove or debulk the tumour. The operation, called a craniotomy, is done under a general anaesthetic and involves opening the skull. The surgeon will cut the scalp and the piece of skull over the tumour, remove the tumour itself and then place up to eight implants in the space where the tumour was. This means chemotherapy can be delivered directly to the site of the brain tumour. The surgeon will then replace the piece of skull and stitch the flap of scalp back in place.
How Gliadel implants work
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The implants dissolve slowly over 2-3 weeks releasing carmustine into the surrounding brain tissue. They don't need to be removed. This type of treatment is only given once.
Each person’s reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has Gliadel implants. We have outlined some of the possible side effects, so you can be aware of them if they occur.
There are always risks from any type of surgery to the brain and these risks may be very slightly increased if you have a Gliadel implant. However, you may have experienced some of the side effects mentioned here either as a result of the brain tumour itself or as a result of the surgery, rather than the Gliadel implant.
It's important to report to your doctor any new or worsening symptoms, such as
confusion or disorientation
problems with infection (the risk of this is slightly higher in people who have had Gliadel implants as opposed to surgery alone).
It can be alarming to see a list like this, but it is important to remember these risks aren't common. We have listed them just so you can be aware of what to look out for. Your neurosurgeon will talk things over with you before your operation. They can answer any questions you may have about what the treatment involves and possible side effects.
The amount of carmustine that gets into the bloodstream is extremely small. Any side effects of the chemotherapy are likely to be less than when the drug is given by tablets or by injection into a vein.
Carmustine can reduce the number of white blood cells produced by the bone marrow, making you more prone to infection. You'll therefore be asked to have a blood test around 10 days after the implants are inserted to check that your bone marrow is working well and producing enough blood cells.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
It's unlikely that chemotherapy given in this way will interact with any other drugs you may be taking. However, it's important that your doctor is aware of any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's possible that treatment with Gliadel implants may cause permanent infertility. You may wish to discuss fertility preservation with your specialist before starting treatment.
It's not advisable to become pregnant or father a child while having treatment with Gliadel implants as it may harm the developing baby. It is necessary to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our Gliadel implants fact sheet, which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.