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Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis

Background: Glioblastoma (GBM) is the most aggressive type of primary malignant brain tumor. Carmustine is used by intravenous injection or local implantation in the resection cavity for gliomas, including GBMs. However, the therapeutic potential of carmustine is not well-recognized. This analysis a...

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Autores principales: Xiao, Zhi-Ze, Wang, Ze-Fen, Lan, Tian, Huang, Wen-Hong, Zhao, Yu-Hang, Ma, Chao, Li, Zhi-Qiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527463/
https://www.ncbi.nlm.nih.gov/pubmed/33041980
http://dx.doi.org/10.3389/fneur.2020.01036
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author Xiao, Zhi-Ze
Wang, Ze-Fen
Lan, Tian
Huang, Wen-Hong
Zhao, Yu-Hang
Ma, Chao
Li, Zhi-Qiang
author_facet Xiao, Zhi-Ze
Wang, Ze-Fen
Lan, Tian
Huang, Wen-Hong
Zhao, Yu-Hang
Ma, Chao
Li, Zhi-Qiang
author_sort Xiao, Zhi-Ze
collection PubMed
description Background: Glioblastoma (GBM) is the most aggressive type of primary malignant brain tumor. Carmustine is used by intravenous injection or local implantation in the resection cavity for gliomas, including GBMs. However, the therapeutic potential of carmustine is not well-recognized. This analysis aimed to evaluate the survival benefits of carmustine in glioma patients, especially those with GBM. Methods: Randomized controlled trials (RCTs) and cohort studies regarding carmustine for glioma treatment were searched in PubMed, the Cochrane Library, and Embase from January 1979 to March 2020. Quality assessment was conducted with Jadad and Newcastle–Ottawa scales (NOS). Statistical analysis was conducted by the Revman 5.3 software. Results: Twenty-two eligible RCTs and cohort studies involving 5,821 glioma patients were included. Overall, glioma patients receiving carmustine as an adjuvant therapy had better progression-free survival [PFS; hazard ratio (HR) = 0.85, 95% CI = 0.77–0.94, P = 0.002] and overall survival (OS; HR = 0.85, 95% CI = 0.79–0.92, P < 0.0001) than those without carmustine treatment. Subgroup analysis showed that the OS benefit was observed in GBM (HR = 0.84, 95% CI = 0.78–0.91, P < 0.00001) but not in anaplastic glioma patients (HR = 1.20, 95% CI = 0.70–2.07, P = 0.50). Additionally, both newly diagnosed and recurrent GBM patients who received carmustine treatment showed better OS (HR = 0.86, 95% CI = 0.79–0.95, P = 0.002; HR = 0.77, 95% CI = 0.67–0.89, P = 0.0002, respectively). Both carmustine implantation in resection cavity and intravenous administration significantly prolonged OS (HR = 0.84, 95% CI = 0.78–0.92, P < 0.0001; HR = 0.86, 95% CI = 0.75–0.99, P = 0.04, respectively). Moreover, GBM patients receiving a combined carmustine and temozolomide (TMZ) therapy had longer OS than those receiving TMZ alone (HR = 0.78, 95% CI = 0.63–0.97, P = 0.03). Conclusion: Carmustine implantation in resection cavity provides survival benefit for GBM patients, and it may be a promising supplement to standard therapeutic protocol by offering a bridge between surgical resection and onset of TMZ therapy.
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spelling pubmed-75274632020-10-09 Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis Xiao, Zhi-Ze Wang, Ze-Fen Lan, Tian Huang, Wen-Hong Zhao, Yu-Hang Ma, Chao Li, Zhi-Qiang Front Neurol Neurology Background: Glioblastoma (GBM) is the most aggressive type of primary malignant brain tumor. Carmustine is used by intravenous injection or local implantation in the resection cavity for gliomas, including GBMs. However, the therapeutic potential of carmustine is not well-recognized. This analysis aimed to evaluate the survival benefits of carmustine in glioma patients, especially those with GBM. Methods: Randomized controlled trials (RCTs) and cohort studies regarding carmustine for glioma treatment were searched in PubMed, the Cochrane Library, and Embase from January 1979 to March 2020. Quality assessment was conducted with Jadad and Newcastle–Ottawa scales (NOS). Statistical analysis was conducted by the Revman 5.3 software. Results: Twenty-two eligible RCTs and cohort studies involving 5,821 glioma patients were included. Overall, glioma patients receiving carmustine as an adjuvant therapy had better progression-free survival [PFS; hazard ratio (HR) = 0.85, 95% CI = 0.77–0.94, P = 0.002] and overall survival (OS; HR = 0.85, 95% CI = 0.79–0.92, P < 0.0001) than those without carmustine treatment. Subgroup analysis showed that the OS benefit was observed in GBM (HR = 0.84, 95% CI = 0.78–0.91, P < 0.00001) but not in anaplastic glioma patients (HR = 1.20, 95% CI = 0.70–2.07, P = 0.50). Additionally, both newly diagnosed and recurrent GBM patients who received carmustine treatment showed better OS (HR = 0.86, 95% CI = 0.79–0.95, P = 0.002; HR = 0.77, 95% CI = 0.67–0.89, P = 0.0002, respectively). Both carmustine implantation in resection cavity and intravenous administration significantly prolonged OS (HR = 0.84, 95% CI = 0.78–0.92, P < 0.0001; HR = 0.86, 95% CI = 0.75–0.99, P = 0.04, respectively). Moreover, GBM patients receiving a combined carmustine and temozolomide (TMZ) therapy had longer OS than those receiving TMZ alone (HR = 0.78, 95% CI = 0.63–0.97, P = 0.03). Conclusion: Carmustine implantation in resection cavity provides survival benefit for GBM patients, and it may be a promising supplement to standard therapeutic protocol by offering a bridge between surgical resection and onset of TMZ therapy. Frontiers Media S.A. 2020-09-17 /pmc/articles/PMC7527463/ /pubmed/33041980 http://dx.doi.org/10.3389/fneur.2020.01036 Text en Copyright © 2020 Xiao, Wang, Lan, Huang, Zhao, Ma and Li. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Xiao, Zhi-Ze
Wang, Ze-Fen
Lan, Tian
Huang, Wen-Hong
Zhao, Yu-Hang
Ma, Chao
Li, Zhi-Qiang
Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title_full Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title_fullStr Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title_full_unstemmed Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title_short Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
title_sort carmustine as a supplementary therapeutic option for glioblastoma: a systematic review and meta-analysis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527463/
https://www.ncbi.nlm.nih.gov/pubmed/33041980
http://dx.doi.org/10.3389/fneur.2020.01036
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