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Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis

BACKGROUND: Many physicians are reluctant to treat elderly glioblastoma (GBM) patients as aggressively as younger patients, which is not evidence based due to the absence of validated data from primary studies. We conducted a meta-analysis to provide valid evidence for the use of the aggressive comb...

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Autores principales: Yin, An-an, Zhang, Lu-hua, Cheng, Jin-xiang, Dong, Yu, Liu, Bo-lin, Han, Ning, Zhang, Xiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782499/
https://www.ncbi.nlm.nih.gov/pubmed/24086323
http://dx.doi.org/10.1371/journal.pone.0074242
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author Yin, An-an
Zhang, Lu-hua
Cheng, Jin-xiang
Dong, Yu
Liu, Bo-lin
Han, Ning
Zhang, Xiang
author_facet Yin, An-an
Zhang, Lu-hua
Cheng, Jin-xiang
Dong, Yu
Liu, Bo-lin
Han, Ning
Zhang, Xiang
author_sort Yin, An-an
collection PubMed
description BACKGROUND: Many physicians are reluctant to treat elderly glioblastoma (GBM) patients as aggressively as younger patients, which is not evidence based due to the absence of validated data from primary studies. We conducted a meta-analysis to provide valid evidence for the use of the aggressive combination of radiotherapy (RT) and temozolomide (TMZ) in elderly GBM patients. METHODS: A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined RT/TMZ with RT alone in elderly patients (≥65 years) with newly diagnosed GBM were eligible for inclusion. RESULTS: No eligible randomized trials were identified. Alternatively, a meta-analysis of nonrandomized studies (NRSs) was performed, with 16 studies eligible for overall survival (OS) analysis and nine for progression-free survival (PFS) analysis. Combined RT/TMZ was shown to reduce the risk of death and progression in elderly GBM patients compared with RT alone (OS hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.48–0.72; PFS: HR 0.58, 95% CI 0.41–0.84). Evaluable patients were reported to tolerate combined treatment but certain toxicities, and especially hematological toxicities, were more frequently observed. Limited data on O6-methylguanine-DNA methyltransferase (MGMT) promoter status and quality of life were reported. CONCLUSION: The meta-analysis of NRSs provided level 2a evidence (Oxford Centre for Evidence-Based Medicine) that combined RT/TMZ conferred a clear survival benefit on a selection of elderly GBM patients who had a favorable prognosis (e.g., extensive resection, favorable KPS). Toxicities were more frequent but acceptable. Future randomized trials are warranted to justify a definitive conclusion.
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spelling pubmed-37824992013-10-01 Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis Yin, An-an Zhang, Lu-hua Cheng, Jin-xiang Dong, Yu Liu, Bo-lin Han, Ning Zhang, Xiang PLoS One Research Article BACKGROUND: Many physicians are reluctant to treat elderly glioblastoma (GBM) patients as aggressively as younger patients, which is not evidence based due to the absence of validated data from primary studies. We conducted a meta-analysis to provide valid evidence for the use of the aggressive combination of radiotherapy (RT) and temozolomide (TMZ) in elderly GBM patients. METHODS: A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined RT/TMZ with RT alone in elderly patients (≥65 years) with newly diagnosed GBM were eligible for inclusion. RESULTS: No eligible randomized trials were identified. Alternatively, a meta-analysis of nonrandomized studies (NRSs) was performed, with 16 studies eligible for overall survival (OS) analysis and nine for progression-free survival (PFS) analysis. Combined RT/TMZ was shown to reduce the risk of death and progression in elderly GBM patients compared with RT alone (OS hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.48–0.72; PFS: HR 0.58, 95% CI 0.41–0.84). Evaluable patients were reported to tolerate combined treatment but certain toxicities, and especially hematological toxicities, were more frequently observed. Limited data on O6-methylguanine-DNA methyltransferase (MGMT) promoter status and quality of life were reported. CONCLUSION: The meta-analysis of NRSs provided level 2a evidence (Oxford Centre for Evidence-Based Medicine) that combined RT/TMZ conferred a clear survival benefit on a selection of elderly GBM patients who had a favorable prognosis (e.g., extensive resection, favorable KPS). Toxicities were more frequent but acceptable. Future randomized trials are warranted to justify a definitive conclusion. Public Library of Science 2013-09-24 /pmc/articles/PMC3782499/ /pubmed/24086323 http://dx.doi.org/10.1371/journal.pone.0074242 Text en © 2013 Yin et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Yin, An-an
Zhang, Lu-hua
Cheng, Jin-xiang
Dong, Yu
Liu, Bo-lin
Han, Ning
Zhang, Xiang
Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title_full Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title_fullStr Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title_full_unstemmed Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title_short Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-Analysis
title_sort radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782499/
https://www.ncbi.nlm.nih.gov/pubmed/24086323
http://dx.doi.org/10.1371/journal.pone.0074242
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