Systematic Review Of The Treatment Of Gliomas After Neurosurgical Resection In Adult

Objective:The aim of the study was to conducte a systematic review to analyze on the effect of radiochemotherapy for anaplastic glioma after neurosurgical resection.Meterials and Methods:Articles were searched from the foreign language databases as PubMed, EMBASE and the Coehrane Library, and the Chinese databases as CBM, CNKI, VIP and Wanfang databases with the searching algorithm, from January1998to March2013. The search terms used include’anaplastic glioma’,’anaplastic astrocytoma’,’anaplastic oligodendroglioma’,’anaplastic oligoastrocytoma’,’radiation therapy’ and’chemotherapy’. The search language included English and Chinese. According with the type of study design, study characteristics interventions and outcome measures, we considered all eligible RCTs by comparing evaluation of radiochemotherapy versus radiation alone in anaplastic glioma after neurosurgical resection. In addition, the quality of trials were critically assessed by the criteria from the Cochrane Reviewer Handbook version5.1.0and all these RCTs were graded from A to C. The OS(Overall survival) and PFS(Progress Free Survival) were used to assess the effectiveness of relevant intervention. Stata software was used for statistical analysis. The X2test was used to compare heterogeneity. Sensitivity analysis was used to evaluate the stability and reliability of the results.Results:1. A search of four trials totally with965patients, including480patients of radiochemotherapy,485patients of radiation alone. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria all these six RCTs received grade B.2. statistical analysis:(1) There were significant differences associated with OS between radiochemotherapy and radiation alone for anaplastic glioma[HR=0.74(95%CI,0.64—0.86)], and anaplastic oligodendroglioma/anaplastic oligoastr-ocytoma [HR=0.72(95%CI,0.60—0.86)]; There were no significant differences associated with OS between radiochemotherapy and radiation alone for anaplastic astrocytom[HR=0.79(95%CI,0.61—1.02)] (2) There were significant differences associated with PFS between radiochemotherapy and radiation alone for anaplastic glioma[HR=0.67(95%CI,0.56—0.79)];(3) There were significant differences associated with OS and PFS between lp19qLOH and lp19qNLOH in the anaplastic oligodendro-glioma/anaplastic oligoastrocytoma [HR=0.41(95%CI,0.23—0.72) and HR=0.43(95%CI,0.38—0.49)];(4) There were significant differences associated with OS and PFS between radiochemotherapy and radiation alone in the subgroup of patients with lp19qLOH [HR=0.58(95%CI,0.40—0.84) and HR=0.45(95%CI,0.32—0.64)].Conclusions:Radiochemotherapy played a beneficial role in the treatment for anaplastic glioma after neurosurgical resection. It could prolong OS and PFS compared with radiotherapy alone. Patients combined loss of1p19q benefited more from radiochemotherapy, and radiotherapy with PCV increased OS and PFS in this subgroup. But it still needs further large randomized control trials to indicate the role of radiochemotherapy in the treatment for anaplastic astrocytoma, anaplastic oligodendro-glioma/anaplastic oligoastrocytoma or subgroup with1p19qLOH or1p19qNLOH. Objective:The aim of the study was to conducte a systematic review to compare the effect in adult patients treated with low-dose versus high-dose radiotherapy for low-grade glioma after neurosurgical resection.Meterials and Methods:Articles were searched from the foreign language databases as PubMed, EMBASE and the Coehrane Library, and the Chinese databases as CBM, CNKI, VIP and Wanfang databases with the searching algorithm, from database up to March2013. The search terms used include’low grade glioma’,’diffuse astrocytoma’,’oligodendroglioma’,’oligoastrocytoma’and’radiation therapy’. The search language included English and Chinese. According with the type of study design, study characteristics interventions and outcome measures, we considered all eligible RCTs by comparing evaluation of low-dose versus high-dose radiation in low grade glioma after neurosurgical resection. In addition, the quality of trials were critically assessed by the criteria frome the Cochrane Reviewer Handbook version5.1.0and all these RCTs were graded from A to C. The OS(Overall survival) and PFS(Progress Free Survival) were used to assess the effectiveness of relevant intervention. RevMan5.1software was used for statistical analysis. The X2test was used to compare heterogeneity. Sensitivity analysis was used to evaluate the stability and reliability of the results.Results:1. A search of two trials totally with546patients, including272patients with low-dose radiation,274patients with high-dose. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria all these two RCTs received grade B.2. Statistical analysis:There were no significant differences associated with OS and PFS between low-dose versus high-dose radiotherapy for low-grade glioma after neurosurgical resection.Conclusions:Results of the systematic review indicated that the difference did not reach the level of significance neither for OS nor for PFS in the high-dose RT arm for low-grade glioma. And it also sugested that slightly higher incidence of radiation necrosis in the high-dose RT arm. The important clinical prognostic factors include age, clinical symptoms, histologic subtype, tumour size and site in the management of patients with LGGs.