Adjuvant chemotherapy for adults with malignant glioma: a systematic review.
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.


CONCLUSIONS
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.
Odette Cancer Centre, Sunnybrook Health Sciences Centre Toronto, Ontario, Canada.
James
J
Perry
Normand
N
Laperriere
Lisa
L
Zuraw
Alexandra
A
Chambers
Karen
K
Spithoff
J Gregory
JG
Cairncross
D001932:Brain Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic