lled delivery by biodegradable polymers ofchemotherapy for recurrent gliomas. Lancet 1995;345:1008-12.
5. Westphal M, Hilt DC, Bortey E, et al. A phase 3 trial oflocal chemotherapy with biodegradable carmustine(BCNU) wafers (Gliadel wafers) in patients with primarymalignant glioma. Neuro-Oncol 2003; 5: 79-88.
6. Westphal M, Ram Z, Riddle V, et al. Gliadel® wafer ininitial surgery for malignant gliomas: longtermfollowupofamulticenter controlled trial. Acta Neurochir 2006;148: 269-75.
GLIADEL WAFER IMPLANT DS 8
Generic Name: CARMUSTINE/POLIFEPROSAN 20
Class: R
Manufacture: ONCOLOGY THERAPEUTICS NET
中文名: 卡莫司汀植入膜剂
Strength: 7.7-192.3
Unit/Case: 1
Unit: UNIT
How to Use GLIADEL® Wafer
Six Steps to Using GLIADEL® Wafer
1. Preparation for Use
Maximize resection of tumor Send tumor specimen to pathologist to confirm malignant glioma Achieve hemostasis before implantation to eliminate bleeding Obtain clear irrigation fluid
2. Handle Wafers carefully due to fragility and toxicity of carmustine
Use double surgical gloves
Use a surgical instrument dedicated to wafer handling
Keep wafer pouches unopened until implantation
3. Opening the GLIADEL pouch (outer surface of foil pouch is not sterile)
Open outer pouch: peel folded corner in outward motion Do not pull downward this may break wafer Remove inner pouch: with forceps, grab crimped edge, pull upwards Open inner pouch: gently hold crimped edge, cut around wafer Remove wafer: gently grasp with forceps, place onto sterile field
4. Implanting GLIADEL
Line resection cavity surface with wafers Cover entire surface of cavity using mosaic pattern, using up to eight wafers (7.7 mg carmustine each) Pack wafers close without stacking; slight overlap and halving wafers are acceptable If necessary,stretch surface area to maximize exposure to wafers Prevent wafer migration into ventricular system and obstructive hydrocephalus by closing any communication larger than a wafer before implantation Dispose of unused wafers
5. Securing the Wafers
Anchor wafers with ½-inch-wide strips of Surgicel® (oxidized cellulose), starting at bottom of cavity and moving up Keep Surgicel® strips 1 layer deep: do not create large mass
6. Ensure watertight dural closure
Take extra care to decrease risk of CSF leaks and infection Suction to ensure no blood in cavity Irrigate resection cavity before closure If necessary, use a graft of autologous, nonsynthetic or synthetic dura patch or substitute Treat CSF leaks aggressively Manage edema withaggressiveandprolongedcorticosteroidtreatmentBeginanticonvulsants before surgery (recommended for all patients) The information described above is a general example intended to help educate individuals on GLIADEL® Wafer. The information provided is neither a substitute for professional medical advice nor intended to provide treatment options. The text and graphics depicted do notreplacetheservicesofaphysicianordoctorpatientrelationship. The use of the information is at the discretion of the reader. The reader should always consult a qualified medical expert in the use of GLIADEL® Wafer. Eisai makes no representations or warranties with respect to any information provided on this graphic and is not liable for any direct or indirect claim, loss or damage resulting from the use of
