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Adjuvant Chemotherapy for Adults with Malignant Glioma: A Systematic Review

Published online by Cambridge University Press:  02 December 2014

James Perry ,
Normand Laperriere ,
Lisa Zuraw ,
Alexandra Chambers ,
Karen Spithoff  and
J. Gregory Cairncross
James Perry
Affiliation:
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
Normand Laperriere
Affiliation:
Princess Margaret Hospital, Toronto, Ontario
Lisa Zuraw
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
Alexandra Chambers
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
Karen Spithoff
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
J. Gregory Cairncross
Affiliation:
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Abstract

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Objective:

This systematic review examines the role of chemotherapy following surgery and external beam radiotherapy for adults with newly diagnosed malignant glioma.

Methods:

MEDLINE, EMBASE, and the Cochrane Library databases were searched to August 2006 to identify relevant randomized controlled trials (RCTs) and meta-analyses. Proceedings from the 1997 to 2006 annual meetings of the American Society of Clinical Oncology were also searched.

Results:

Two RCTs reported a survival advantage in favour of radiotherapy with concomitant and adjuvant temozolomide compared with radiotherapy alone in patients with anaplastic astrocytoma or glioblastoma. Twenty-six RCTs and two meta-analyses detected either no advantage or a small survival advantage in favour of adjuvant chemotherapy.

Conclusion:

Concomitant temozolomide during radiotherapy and post-radiation adjuvant temozolomide is recommended for all patients ages 18-70 with newly diagnosed glioblastoma multiforme who are fit for radical therapy (ECOG 0-1). Temozolomide may be considered in other situations (i.e., ECOG 2, biopsy only, age >70, intermediate grade glioma), but there is no high-level evidence to support this decision. Moreover, there are few data on long-term toxicities or quality of life with temozolomide. Adjuvant chemotherapy may be an option for younger patients with anaplastic (grade 3) astrocytoma and patients with pure or mixed oligodendroglioma. However, there is no evidence of a survival advantage from adjuvant chemotherapy in these patients, and treatment-related adverse effects and their impact upon quality of life are poorly studied. The combination of procarbazine, lomustine, and vincristine (PCV) is not recommended for patients with anaplastic oligodendroglioma and oligoastrocytoma.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Objectif</span></span>:

Cette revue systématique examine le rôle de la chimiothérapie administrée après la chirurgie et la radiothérapie externe chez les adultes porteurs d’un gliome malin dont le diagnostic est récent.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Nous avons identifié les essais contrôlés randomisés (ECRs) pertinents ainsi que les méta-analyses dans les bases de données MEDLINE, EMBASE et la Cochrane Library jusqu’en août 2006. Nous avons également révisé les comptes rendus des réunions annuelles de l’American Society of Clinical Oncology.

<span class='italic'> <span class='bold'>Résultats</span></span>:

Deux ECRs ont rapporté un bénéfice quant à la survie avec le témozolomide comme traitement adjuvant administré en même temps que la radiothérapie par rapport à la radiothérapie seule chez des patients porteurs d’un astrocytome anaplasique ou d’un glioblastome. Vingt-six ECRs et deux méta-analyses n’ont pas mis en évidence d’avantage ou ont démontré un faible avantage quant à la survie avec la chimiothérapie adjuvante.

<span class='italic'> <span class='bold'>Conclusion</span></span>:

L’administration de témozolomide pendant la radiothérapie et son administration adjuvante après l’irradiation est recommandée chez tous les patients entre 18 et 70 ans chez qui on vient de poser un diagnostic de glioblastome multiforme et dont l’état général le permet (ECOG 0-1). On peut envisager le traitement par le témozolomide dans d’autres situations (c’est-à-dire ECOG 2, biopsie seulement, âge < 70 ans, gliome de grade intermédiaire), mais il n’existe pas de données probantes à cet effet. De plus, il existe peu de données sur la toxicité à long terme du témozolomide ou sur la qualité de vie. La chimiothérapie adjuvante peut être une option chez les patients plus jeunes qui sont porteurs d’un astrocytome anaplasique (grade 3) et les patients porteurs d’un oligodendrogliome pure ou mixte. Cependant, un avantage quant à la survie n’a pas été démontré avec l’administration de la chimiothérapie adjuvante chez ces patients et les effets secondaires et leur impact sur la qualité de vie ont été mal étudiés. La combinaison procarbazine, lomustine et vincristine (PCV) n’est pas recommandée chez les patients porteurs d’un oligodendrogliome ou d’un oligoastrocytome anaplasique.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 402 - 410
Copyright
Copyright © The Canadian Journal of Neurological 2007

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