Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Sep 24;8(9):e74242.
doi: 10.1371/journal.pone.0074242. eCollection 2013.

Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis

An-an Yin  1 , Lu-hua Zhang, Jin-xiang Cheng, Yu Dong, Bo-lin Liu, Ning Han, Xiang Zhang
Affiliations
Meta-Analysis

Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis

An-an Yin et al. PLoS One. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of study selection.
Figure 2
Figure 2. Forest plot of comparison: Combined RT/TMZ versus RT alone, outcome: a) overall survival; b) progression-free survival.
Figure 3
Figure 3. The aggregate estimate for the incidence of patients who experienced at least one grade 3–4 hematological adverse event in combined RT/TMZ groups.
Figure 4
Figure 4. Funnel plot of comparison: Combined RT/TMZ versus RT alone, outcome: a) overall survival; b) progression-free survival.
See this image and copyright information in PMC

References

    1. Wen PY, Kesari S (2008) Malignant gliomas in adults. N Engl J Med 359: 492–507. - PubMed
    1. Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64: 628–634. - PubMed
    1. Kita D, Ciernik IF, Vaccarella S, Franceschi S, Kleihues P, et al. (2009) Age as a predictive factor in glioblastomas: population-based study. Neuroepidemiology 33: 17–22. - PubMed
    1. Siu LL (2007) Clinical trials in the elderly–a concept comes of age. N Engl J Med 356: 1575–1576. - PubMed
    1. Laperriere N, Weller M, Stupp R, Perry JR, Brandes AA, et al. (2012) Optimal management of elderly patients with glioblastoma. Cancer Treat Rev. DOI: 10.1016/j.ctrv.2012.05.008. - DOI - PubMed

Publication types