不同干预措施在高龄和(或)体弱胶质母细胞瘤中应用的网状meta分析
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摘要
目的探索在新诊断的高龄和(或)体弱的胶质母细胞瘤患者中何种干预措施更加合理、有效。方法检索Pubmed、Cochrane、Embase、知网、万方、维普、CBM各数据库;对纳入文章进行质量评估,数据提取后采用Stata13.0进行网状meta分析。结果纳入分析的7种不同干预措施,其干预效果排序从最优到最差分别为:大分割放疗结合替莫唑胺治疗方案、大分割放疗和短期放疗方案、单独替莫唑胺治疗方案、大分割放疗结合贝伐单抗治疗方案、标准放疗方案、支持治疗;其中最优治疗方案为大分割放疗结合替莫唑胺治疗方案。结论本研究分析揭示:在具有较好性能状态的新诊断老年胶质母细胞瘤患者中,大分割放疗结合替莫唑胺治疗方案是一个合理的选择;另外,在老年和(或)体弱的新诊断胶质母细胞瘤患者中,选择大分割/短期放疗方案和单独替莫唑胺治疗方案更加合理。
Objective To explore which interventions were more reasonable and effective in patients withnewly diagnosed elderly and/or frail glioblastoma. Methods Pubmed,Cochrane,Embase,CNKI,CBM,Wanfang,VIP databases were searched respectively. The quality of included documents were assessed to extractnetwork meta-analysis data using the statistical software Stata 13.0. Results Among the seven differentinterventions included in the analysis,the intervention effect were sorted from the best to the worst as follows:hypofractionated radiotherapy combined with temozolomide,hypofractionated radiotherapy and short-courseradiotherapy, temozolomide alone, hypofractionated radiotherapy combined with bevacizumab, the standardradiotherapy, supportive care. Conclusions Our study showed that the intervention of hypofractionatedradiotherapy combined with temozolomide was a reasonable choice in patients with newly diagnosed elderlyglioblastoma. In addition,the interventions of hypofractionated/short-course radiotherapy and temozolomide alonewere more reasonable in the patients with newly diagnosed elderly and/or frail glioblastoma.
Objective To explore which interventions were more reasonable and effective in patients withnewly diagnosed elderly and/or frail glioblastoma. Methods Pubmed,Cochrane,Embase,CNKI,CBM,Wanfang,VIP databases were searched respectively. The quality of included documents were assessed to extractnetwork meta-analysis data using the statistical software Stata 13.0. Results Among the seven differentinterventions included in the analysis,the intervention effect were sorted from the best to the worst as follows:hypofractionated radiotherapy combined with temozolomide,hypofractionated radiotherapy and short-courseradiotherapy, temozolomide alone, hypofractionated radiotherapy combined with bevacizumab, the standardradiotherapy, supportive care. Conclusions Our study showed that the intervention of hypofractionatedradiotherapy combined with temozolomide was a reasonable choice in patients with newly diagnosed elderlyglioblastoma. In addition,the interventions of hypofractionated/short-course radiotherapy and temozolomide alonewere more reasonable in the patients with newly diagnosed elderly and/or frail glioblastoma.
引文
[1]宋向奇,李梅,付爱军,等.高剂量替莫唑胺治疗在胶质母细胞瘤中应用的网状Meta分析[J].实用医学杂志,2017,33(23):3990-3994.
[2]山常国,赖名耀,洪伟平,等.长周期替莫唑胺治疗胶质母细胞瘤[J].实用医学杂志,2017,33(16):2743-2746.
[3] ROA W,KEPKA L,KUMAR N,et al. International atomic en-ergy agency randomized phase iii study of radiation therapy inelderly and/or frail patients with newly diagnosed glioblastomamultiforme[J]. J Clin Oncol,2015,33(35):4145.
[4] ARVOLD N D,REARDON D A. Treatment options and out-comes for glioblastoma in the elderly patient[J]. Clin Interv Ag-ing,2014,21(9):357-367.
[5] FIORENTINO A,DE BONIS P,CHIESA S. Elderly patientswith glioblastoma:the treatment challenge[J]. Expert Rev Neu-rother,2013,13(10):1099-1105.
[6] DE MORAES F Y,LAPERRIERE N. Glioblastoma in the elderly:initial management[J]. Chin Clin Oncol,2017,6(4):39.
[7] ALMADANI A,SANJAY D,CHRIS R H,et al. Managementof elderly patients with glioblastoma-multiforme-a systematic re-view[J]. Br J Radiol,2018,91(1088):20170271.
[8] ROA W,BRASHER P M,BAUMAN G,et al. Abbreviatedcourse of radiation therapy in older patients with glioblastomamultiforme:a prospective randomized clinical trial[J]. J ClinOncol,2004,22(9):1583-1588.
[9] WICK W,PLATTEN M,MEISNER C,et al. Temozolomidechemotherapy alone versus radiotherapy alone for malignant as-trocytoma in the elderly:the NOA-08 randomised,phase 3 trial[J]. Lancet Oncol,2012,13(7):707.
[10] MALMSTR?M A,GR?NBERG BH,MAROSI C,et al. Temo-zolomide versus standard 6-week radiotherapy versus hypofrac-tionated radiotherapy in patients older than 60 years with glio-blastoma:the Nordic randomised,phase 3 trial[J]. Lancet On-col,2012,13(9):916-926.
[11] LAPERRIER N,WELLER M,STUPP R,et al. Optimal man-agement of elderly patients with glioblastoma[J]. Cancer TreatRev,2013,39(4):350-357.
[12] FRANCESCHI E, DEPENNI R, PACCAPELO A, et al.Which elderly newly diagnosed glioblastoma patients can bene-fit from radiotherapy and temozolomide?A PERNO prospectivestudy[J]. J Neurooncol,2016,128(1):157-162.
[13] KEIME-GUIBERT F,CHINOT O,TAILLANDIER L,et al.Radiotherapy for glioblastoma in the elderly[J]. N Engl J Med,2007,11(5):1527-1535.
[14] HARRISON R A,DE GROOT J F. Treatment of glioblastomain the elderly[J]. Drugs Aging,2018,35(8):707-718.
[15] PERRY J R,LAPERRIERE N,O′CALLAGHAN C J,et al.Short-course radiation plus temozolomide in elderly patientswith glioblastoma[J]. N Engl J Med,2017,376(11):1027-1037.
[16] WIRSCHING H G,TABATABAI G,ROELCKE U,et al. Bev-acizumab plus hypofractionated radiotherapy versus radiothera-py alone in elderly patients with glioblastoma:the randomized,open-label,phase II ARTE trial[J]. Ann Oncol,2018,29(6):1423-1430.
[2]山常国,赖名耀,洪伟平,等.长周期替莫唑胺治疗胶质母细胞瘤[J].实用医学杂志,2017,33(16):2743-2746.
[3] ROA W,KEPKA L,KUMAR N,et al. International atomic en-ergy agency randomized phase iii study of radiation therapy inelderly and/or frail patients with newly diagnosed glioblastomamultiforme[J]. J Clin Oncol,2015,33(35):4145.
[4] ARVOLD N D,REARDON D A. Treatment options and out-comes for glioblastoma in the elderly patient[J]. Clin Interv Ag-ing,2014,21(9):357-367.
[5] FIORENTINO A,DE BONIS P,CHIESA S. Elderly patientswith glioblastoma:the treatment challenge[J]. Expert Rev Neu-rother,2013,13(10):1099-1105.
[6] DE MORAES F Y,LAPERRIERE N. Glioblastoma in the elderly:initial management[J]. Chin Clin Oncol,2017,6(4):39.
[7] ALMADANI A,SANJAY D,CHRIS R H,et al. Managementof elderly patients with glioblastoma-multiforme-a systematic re-view[J]. Br J Radiol,2018,91(1088):20170271.
[8] ROA W,BRASHER P M,BAUMAN G,et al. Abbreviatedcourse of radiation therapy in older patients with glioblastomamultiforme:a prospective randomized clinical trial[J]. J ClinOncol,2004,22(9):1583-1588.
[9] WICK W,PLATTEN M,MEISNER C,et al. Temozolomidechemotherapy alone versus radiotherapy alone for malignant as-trocytoma in the elderly:the NOA-08 randomised,phase 3 trial[J]. Lancet Oncol,2012,13(7):707.
[10] MALMSTR?M A,GR?NBERG BH,MAROSI C,et al. Temo-zolomide versus standard 6-week radiotherapy versus hypofrac-tionated radiotherapy in patients older than 60 years with glio-blastoma:the Nordic randomised,phase 3 trial[J]. Lancet On-col,2012,13(9):916-926.
[11] LAPERRIER N,WELLER M,STUPP R,et al. Optimal man-agement of elderly patients with glioblastoma[J]. Cancer TreatRev,2013,39(4):350-357.
[12] FRANCESCHI E, DEPENNI R, PACCAPELO A, et al.Which elderly newly diagnosed glioblastoma patients can bene-fit from radiotherapy and temozolomide?A PERNO prospectivestudy[J]. J Neurooncol,2016,128(1):157-162.
[13] KEIME-GUIBERT F,CHINOT O,TAILLANDIER L,et al.Radiotherapy for glioblastoma in the elderly[J]. N Engl J Med,2007,11(5):1527-1535.
[14] HARRISON R A,DE GROOT J F. Treatment of glioblastomain the elderly[J]. Drugs Aging,2018,35(8):707-718.
[15] PERRY J R,LAPERRIERE N,O′CALLAGHAN C J,et al.Short-course radiation plus temozolomide in elderly patientswith glioblastoma[J]. N Engl J Med,2017,376(11):1027-1037.
[16] WIRSCHING H G,TABATABAI G,ROELCKE U,et al. Bev-acizumab plus hypofractionated radiotherapy versus radiothera-py alone in elderly patients with glioblastoma:the randomized,open-label,phase II ARTE trial[J]. Ann Oncol,2018,29(6):1423-1430.