title: Effects of Temozolomide and Radiotherapy on Brain Metastatic Tumor: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To systematically evaluate safety and efficacy of temozolomide plus radiotherapy in the treatment of brain metastasis.
  
  
  METHODS
  Literature was searched in the following databases: Cochrane Controlled Trials Register (CENTRAL), PubMed (1994-2015.10), CBM (1978-2015.10), CNKI (1994-2015.10), VIP (1994-2015.10), and WANFANG (1994-2015.10). Randomized clinical trials (RCTs) of temozolomide plus radiotherapy in comparison with radiotherapy alone were included in this review and meta-analysis. The quality of included literatures was assessed by the international Cochrane collaboration method, and meta-analysis was performed using RevMan 5.0 software.
  
  
  RESULTS
  Total 19 publications of RCTs were included, and there was no allocation concealment or blinding in any of them. Six of the 19 were multicenter RCTs. Overall response rate (ORR) was in favor of radiotherapy plus temozolomide (risk ratio [RR] = 1.35, 95% CI: 1.23-1.47). Subgroup analysis of non-small cell lung cancer (NSCLC) metastasis brain tumor also showed that ORR was in favor of radiotherapy plus temozolomide (RR = 1.38; 95% CI: 1.17-1.63). Progression-free survival (PFS) or overall survival rate, however, was not significantly different between the 2 treatment groups. In addition, incidence of side effect was significantly higher in the group of radiotherapy plus temozolomide than that of radiotherapy alone (HR = 2.03, 95% CI: 1.56-2.64).
  
  
  CONCLUSIONS
  Addition of temozolomide to radiotherapy could increase ORR in brain metastatic tumors. However, it did not significantly improve PFS or OS in the patients with brain metastases but increased risk of drug-related toxicity.
authors.affiliation: Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Ma
authors.affiliation: Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: An
authors.affiliation: Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Changpeng
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Changwen
authors.initials: C
authors.lastname: Bo
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. Electronic address: zhangguangyu151212@163.com.
authors.forename: Guangyu
authors.initials: G
authors.lastname: Zhang
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D006801:Humans; D011878:Radiotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Brain metastases; Meta-analysis; Radiotherapy; Temozolomide