title: Treatment arms summarizing analysis of 220 high-grade glioma studies.
abstract: Large phase III studies have identified limited survival benefits with chemotherapy in high-grade glioma. However, numerous clinical trials have been published previously with smaller patient numbers and no control groups. A small positive effect could be missed this way, resulting in premature rejection of possible beneficial treatment. In order to perform a treatment arm summarizing analysis (TASA), a database was created summarizing treatments published between January 1976 and June 2002. In this database, one record represents a cohort of patients treated in the same way. Various patient cohort characteristics such as median age, and outcome measures including median overall survival times (mOS), were documented. Two-hundred and twenty publications were documented with a total number of 17,213 cases treated in 337 treatment groups. There was a statistically significant relationship between the distribution of histological grades (p<0.001) and the outcome, and a better outcome in younger patient populations (p<0.01). However, the known influence of the median Karnowsky performance scale could not be confirmed in this database. The extent of surgery showed a positive influence only when excluding relapse studies, while the positive effect of radiation was clear in all subgroups (p<0.05). Clinical studies that included nitrosurea in the treatment had a significantly better outcome than those with platinum drugs or without chemotherapy. We conclude that TASA, representing a novel way to perform a meta-analysis, is valid since it confirms the known treatment effects and, therefore, has the potential to provide new insights by combining information from different clinical treatment studies.
authors.affiliation: Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Steinmetzstr. 1-3, D-93049 Regensburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Hauch
authors.forename: Mitra
authors.initials: M
authors.lastname: Sajedi
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff
mesh_terms: D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D016208:Databases, Factual; D005260:Female; D005910:Glioma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome