A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients
A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients
复制标题
老年胶质母细胞瘤患者替莫唑胺与放疗的荟萃分析
DOI：
10.1007/s11060-013-1294-0
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发表时间：
2013
影响因子：
3.9
通讯作者：
Zhang, Xiang
中科院分区：
文献类型：
--
作者：
Zhang, Lu-hua;Liu, Bo-lin;Cheng, Jin-xiang;Zhang, Xiang
替莫唑胺(TMZ)已被认为是老年胶质母细胞瘤(GBM)患者放射治疗(RT)的一种有前途的替代方案。我们报告了一项系统评价老年GBM患者使用TMZ单一疗法的荟萃分析。使用PubMed、EMBASE和Cochrane数据库进行系统的文献检索。对新诊断为≥的老年患者(65岁)进行替马西汀与放疗的比较研究符合纳入条件。两项随机临床试验(RCT)和三项比较研究显示，与RT相比，TMZ的总体生存(OS)优势(HR[风险比]0.86，95%CI[可信区间]0.74-1.00)。然而，对2个随机对照试验的敏感性分析仅支持其非劣势(HR 0.91，95%CI 0.66-1.27)。大多数老年患者耐受TMZ，尽管3-4级(G3-4)毒性的风险增加，特别是血液学毒性。两组之间的生活质量相似。在MGMT分析中，在接受TMZ单一治疗的老年患者中，甲基化肿瘤与非甲基化肿瘤的OS相关(HR 0.50，95%CI 0.35-0.70)。此外，在甲基化肿瘤患者中，TMZ在改善OS方面比单纯RT更有利(TMZ与RT：HR 0.66，95%CI 0.47-0.93)，而对于非甲基化肿瘤患者则相反(HR 1.32，95%CI 1.00-1.76)。尽管荟萃分析显示在改善OS方面不逊于RT，但TMZ本身并不是老年GBM患者的直接解决方案，因为G3-4毒性，特别是血液学毒性的风险增加。MGMT检测可能有助于确定个体化治疗。
Temozolomide (TMZ) alone has been proposed as a promising alternative to radiotherapy (RT) in elderly glioblastoma (GBM) patients. We report a meta-analysis to systematically evaluate TMZ monotherapy in older GBM patients. A systematic literature search was performed using PubMed, EMBASE and the Cochrane database. Studies comparing TMZ versus RT in elderly patients (≥65 years) with newly diagnosed GBM were eligible for inclusion. Two randomized clinical trials (RCTs) and three comparative studies were included in the analyses, which revealed an overall survival (OS) advantage for TMZ compared with RT (HR [hazard ratio] 0.86, 95 % CI [confidence interval] 0.74–1.00). However, a sensitivity analysis of 2 RCTs only supported its non-inferiority (HR 0.91, 95 % CI 0.66–1.27). Most elderly patients tolerated TMZ despite an increased risk of grade 3–4 (G3–4) toxicities, especially hematological toxicities. The quality of life was similar between the groups. In the MGMT analysis, methylated tumors were associated with a longer OS than unmethylated tumors among elderly patients receiving TMZ monotherapy (HR 0.50, 95 % CI 0.35–0.70). Moreover, in patients with methylated tumors, TMZ was more beneficial than RT alone in improving OS (TMZ vs. RT: HR 0.66, 95 % CI 0.47–0.93) whereas the opposite was true for those with unmethylated tumors (HR 1.32, 95 % CI 1.00–1.76). Although the meta-analysis demonstrated the non-inferiority to RT in improving OS, TMZ alone was not a straightforward solution for elderly GBM patients because of an increased risk of G3–4 toxicities, especially hematological toxicities. MGMT testing might be helpful for determining individualized treatment.
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影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G
影响因子：
6.4
作者：
Reifenberger, Guido;Hentschel, Bettina;Weller, Michael
通讯作者：
Weller, Michael
DOI：
10.1016/s1040-1741(08)70253-7
发表时间：
2006
期刊：
Yearbook of Oncology
影响因子：
--
作者：
P. Loehrer
通讯作者：
P. Loehrer
影响因子：
3.9
作者：
M. Chamberlain;L. Chalmers
通讯作者：
M. Chamberlain;L. Chalmers
影响因子：
45.3
作者：
MACDONALD, DR;CASCINO, TL;CAIRNCROSS, JG
通讯作者：
CAIRNCROSS, JG