Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis.
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 r...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3782499?pdf=render |
| _version_ | 1819011160623546368 |
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| author | An-an Yin Lu-hua Zhang Jin-xiang Cheng Yu Dong Bo-lin Liu Ning Han Xiang Zhang |
| author_facet | An-an Yin Lu-hua Zhang Jin-xiang Cheng Yu Dong Bo-lin Liu Ning Han Xiang Zhang |
| author_sort | An-an Yin |
| collection | DOAJ |
| description | 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.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.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.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. |
| first_indexed | 2024-12-21T01:23:45Z |
| format | Article |
| id | doaj.art-168745b111cc4ed78c6acd7417949f8a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T01:23:45Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-168745b111cc4ed78c6acd7417949f8a2022-12-21T19:20:34ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0189e7424210.1371/journal.pone.0074242Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis.An-an YinLu-hua ZhangJin-xiang ChengYu DongBo-lin LiuNing HanXiang ZhangMany 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.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.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.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.http://europepmc.org/articles/PMC3782499?pdf=render |
| spellingShingle | An-an Yin Lu-hua Zhang Jin-xiang Cheng Yu Dong Bo-lin Liu Ning Han Xiang Zhang Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis. PLoS ONE |
| 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 |
| url | http://europepmc.org/articles/PMC3782499?pdf=render |
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