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Meta-analysis
of radiation therapy with and without adjuvant chemotherapy for malignant
gliomas in adults
Fine
HA, Dear KB, Loeffler JS, Black PM, Canellos GP
Division
of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115
Background.
The value of chemotherapy after standard postoperative external beam radiation
in the treatment of malignant gliomas remains controversial.
Despite recent recommendations from the Brain Tumor Cooperative Group that
chemotherapy should be considered part of the standard treatment of patients
with high-grade astrocytomas, several recent trials have questioned the efficacy
of this approach.
Methods.
Using results from 16 randomized clinical trials involving more than 3000
patients, the authors compared the survival rates of patients who received
radiation alone or radiation with chemotherapy.
The combined data were analyzed using the statistical method of meta-analysis as
described by DerSimonian and Laird.
Results.
The estimated increase in survival for patients treated with combination
radiation and chemotherapy was 10.1% at 1 year (95% confidence interval, 6.8,
13.3%) and 8.6% at 2 years (5.2, 12.0%).
These absolute increases in survival (treated-control [TC]) in patients treated
with chemotherapy represent relative increases (T-C)/C of 23.4% at 1 year (15.8,
30.9%) and 52.4% at 2 years (31.7, 73.2%).
This survival advantage is conferred by several different chemotherapeutic
agents.
When the prognostic variables of age and histology are factored into the
analysis, however, the data suggest that the survival benefit from chemotherapy
occurs earlier in patients with anaplastic astrocytoma (AA) than in patients
with glioblastoma.
Conclusions.
The authors concluded that chemotherapy is advantageous for patients with
malignant gliomas and should be considered part of the standard therapeutic
regimen.
Additional randomized trials using optimal radiation and chemotherapy may still
be needed to precisely define which subgroups of patients, based on prognostic
variables, will benefit most from chemotherapy after radiation.
PMID:
8453582 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8453582&dopt=Abstract
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