Risk management in the treatment of malignant gliomas with BCNU wafer implants. 
Implantation of BCNU wafers (Gliadel®) into the resection cavity has demonstrated a survival benefit for patients with newly diagnosed malignant gliomas.  The follow-up of two phase III trails has further shown that the number of long-term survivors was significantly increased by BCNU wafer treatment.  BCNU wafer implantation may be integrated into current multimodal first line strategies.  In the setting of recurrent disease BCNU wafer implantation has also shown a survival benefit and now extends the treatment options in a patient population that typically has undergone extensive pretreatment.  An analysis of the literature has helped to clearly identify the risks associated with topic BCNU treatment.  Here we summarize the incidence and time course of adverse events associated with local chemotherapy and propose solutions.  The growing body of experience with BCNU wafer implantation may serve as a basis to develop adequate risk management strategies with regard to patient selection, surgical techniques, and follow-up schedules.