Meta-analysis of temozolomide combined with IMRT in treatment of postoperative malignant glioma in China

Abstract

Abstract: AIM: To compare the clinical effects and safety of brain malignant glioma treated with postoperative IMRT combined with TMZ chemotherapy and with IMRT only, to provide reference for clinical treatment and clinical research. METHODS: By searching CNKI,CBM,VIP and Wanfang databases,the studies were included if they were in accordance with inclusion criteria. Data were extracted and evaluated, then analyzed using RevMan 5.0.23. RESULTS: 9 studies were included with a total of 457patients (220T/237C). Meta-analysis results were as follows: The total effective rate of the test group received postoperative IMRT combined with TMZ chemotherapy was higher than that in the control group received radiotherapy only,the difference was statistically significant[OR=3.63,95% CI(2.34,5.62)];The one-year、two-year and three-year survival rate of study group were higher than those in the control group,the difference was statistically significant[OR=2.39, 95%CI(1.50, 3.81)(one-year); OR=2.20, 95% CI(1.11, 4.38)(two-year); OR=2.00, 95% CI(0.81, 4.94)(three-year)]. IMRT combined TMZ can obviously improve the brain malignant glioma chemotherapy curative effect. CONCLUSION: The clinical effects of brain malignant glioma treated with postoperative IMRT combined with TMZ chemotherapy was better than with IMRT only. But due to the low quality of research, it still needs more high quality, large sample, randomized, double-blind and placebo-controlled research to confirm this conclusion.

Key words: glioma, IMRT, TMZ, Meta-analysis

CLC Number:

R311

YAN Yuan-liang, QIAN Long, GONG Zhi-cheng. Meta-analysis of temozolomide combined with IMRT in treatment of postoperative malignant glioma in China[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(1): 64-69.

References

[1] 许志强, 徐伦山, 蒋晓江, 等. 脑胶质瘤的临床治疗进展[J]. 中国临床神经科学, 2010, 18(4): 431-435.
[2] 吴春华. 替莫唑胺联合放疗治疗脑胶质瘤术后复发患者28例疗效观察[J]. 中国实用神经疾病杂志, 2011, 14(24):73-74.
[3] Chang L, Su J, Jia X, et al. Treating malignant glioma in Chinese patients: update on temozolomide[J]. Onco Targets Ther, 2014, 12(7):235-244.
[4] Reddy K, Gaspar LE, Kavanagh BD, et al. Hypofractionated intensity-modulated radiotherapy with temozolomide chemotherapy may alter the patterns of failure in patients with glioblastoma multiforme[J]. J Med Imag Radiat Oncol, 2014 Jun 26[Epub ahead of print].
[5] Yoon SM, Kim JH, Kim SJ, et al.Hypofractionated intensity-modulated radiotherapy using simultaneous integrated boost technique with concurrent and adjuvant temozolomide for glioblastoma[J]. Tumori, 2013, 99(4):480-487.
[6] 陈娜,刘秀英,吴君心, 等.脑胶质瘤术后调强放疗联合替莫唑胺化疗的疗效分析[J].福建医科大学学报, 2010, 44(5):363-366.
[7] 胡江,潘军,骆志国, 等.脑胶质瘤术后调强放疗联合替莫唑胺化疗的疗效分析[J].中国医药导报, 2012,9(21):166-167.
[8] 金雯雯,张红雁,王业涛,等.替莫唑胺联合适形调强放射治疗MGMT阳性的高级别脑胶质瘤临床疗效观察[J].蚌埠医学院学报, 2013,38(1):56-58.
[9] 黄蕾,陈诚,吴俚蓉,等.替莫唑胺联合调强放疗治疗高级别胶质瘤的近期疗效和不良反应的临床观察[J].中国医药指南, 2013, 11(33):318-319.
[10] 王振华,王建华,郭小奇,等.调强放疗联合替莫唑胺胶囊治疗成人Ⅲ～Ⅳ级胶质瘤术后残留临床疗效观察[J].中国全科医学, 2013,16(33):3962-3964.
[11] 刘桂超,胡学锋,黄国森,等.调强放疗联合替莫唑胺同期化疗治疗恶性脑胶质瘤术后残留病灶的近期疗效[J].中国现代医药杂志, 2013,15(8):23-26.
[12] 陈达桂,李桂生,黄海欣,等.调强放疗联合替莫唑胺治疗颅内恶性胶质瘤术后临床观察[J].中国医药导报, 2012,9(8):76-77,80.
[13] 吴金通,彭俊英,吴陈宾,等.调强放疗联合替莫唑胺治疗脑胶质瘤术后残余病灶患者的研究[J].中国实用神经疾病杂志, 2014,17(10):61-62.
[14] 张玉宇,曲雅勤,姜新,等.调强适形放射治疗联合替莫唑胺化疗治疗恶性脑胶质瘤的近期疗效及安全性评价[J].吉林大学学报(医学版),2012,38(3):571-574.
[15] Chen YD, Feng J, Fang T, et al. Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme[J]. Chin Med J (Engl),2013, 126(12):2320-2324.
[16] Jastaniyah N, Murtha A, Pervez N, et al. Phase I study of hypofractionated intensity modulated radiation therapy with concurrent and adjuvant temozolomide in patients with glioblastoma multiforme[J]. Radiat Oncol, 2013,8(38):1-9.
[17] Bei R, Marzocchella L, Turriziani M. The use of temozolomide for the treatment of malignant tumors: clinical evidence and molecular mechanisms of action[J]. Recent Pat Anticancer Drug Discov, 2010, 5(3):172-187.
[18] Querfeld C, Rosen ST, Guitart J, et al. Multicenter phase II trial of temozolomide in mycosis fungoides/sezary syndrome: correlation with O? -methylguanine-DNA methyltransferase and mismatch repair proteins[J]. Clin Cancer Res, 2011, 17(17):5748-5754.
[19] Papsdorf K, Steinbach JP, Sabel M, et al. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial[J]. Lancet Oncol, 2012,13(7):707-715.
[20] Ammirati M, Chotai S, Newton H, et al. Hypofractionatednintensity modulated radiotherapy with temozolomide in newly diagnosed glioblastoma multiforme[J]. J Clin Neurosci, 2014, 21(4):633-637.
[21] Panet-Raymond V, Souhami L, Roberge D, et al. Accelerated hypofractionated intensity-modulated radiotherapy with concurrent and adjuvant temozolomide for patients with glioblastoma multiforme: a safety and efficacy analysis[J]. Int J Radiat Oncol Biol Phys, 2009, 73(2):473-478.
[22] Chen C, Damek D, Gaspar LE, et al. Phase I trial of hypofractionated intensity-modulated radiotherapy with temozolomide chemotherapy for patients with newly diagnosed glioblastoma multiforme[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4):1066-1074.
[23] Fan CH, Liu WL, Cao H, et al. O6-methylguanine DNA methyltransferase as a promising target for the treatment of temozolomide-resistant gliomas[J]. Cell Death Dis, 2013,10(4):e876.
[24] Markman JL, Rekechenetskiy A, Holler E, et al. Nanomedicine therapeutic approaches to overcome cancer drug resistance[J]. Adv Drug Deliv Rev. 2013,65(13-14):1866-79.
[25] Jiang G, Wei ZP, Pei DS, et al. A novel approach to overcome temozolomide resistance in glioma and melanoma: Inactivation of MGMT by gene therapy[J]. Biochem Biophys Res Commun, 2011, 406(3): 311-314.
[26] Beier D, Schulz JB, Beier CP. Chemoresistance of glioblastoma cancer stem cells--much more complex than expected[J]. Mol Cancer, 2011, 10(128): 1-11.