Radiotherapy Plus Concurrent or Sequential Temozolomide for Glioblastoma in the Elderly: A Meta-AnalysisReportar como inadecuado




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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.



Autor: An-an Yin , Lu-hua Zhang , Jin-xiang Cheng , Yu Dong, Bo-lin Liu, Ning Han, Xiang Zhang

Fuente: http://plos.srce.hr/



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