Department of Radiation Oncology, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Australia.
J Neurooncol. 2023 Sep;164(3):505-524. doi: 10.1007/s11060-023-04441-0. Epub 2023 Sep 21.
This review compares reirradiation (reRT), systemic therapy and combination therapy (reRT & systemic therapy) with regards to overall survival (OS), progression-free survival (PFS), adverse effects (AEs) and quality of life (QoL) in patients with recurrent high-grade glioma (rHGG).
A search was performed on PubMed, Scopus, Embase and CENTRAL. Studies reporting OS, PFS, AEs and/or QoL and encompassing the following groups were included; reirradiation vs systemic therapy, combination therapy vs systemic therapy, combination therapy vs reRT, and bevacizumab-based combination therapy vs reRT with/without non-bevacizumab-based systemic therapy. Meta-analyses were performed utilising a random effects model. Certainty of evidence was assessed using GRADE.
Thirty-one studies (three randomised, twenty-eight non-randomised) comprising 2084 participants were included. In the combination therapy vs systemic therapy group, combination therapy improved PFS (HR 0.57 (95% CI 0.41-0.79); low certainty) and OS (HR 0.73 (95% CI 0.56-0.95); low certainty) and there was no difference in grade 3 + AEs (RR 1.03 (95% CI 0.57-1.86); very low certainty). In the combination therapy vs reRT group, combination therapy improved PFS (HR 0.52 (95% CI 0.38-0.72); low certainty) and OS (HR 0.69 (95% CI 0.52-0.93); low certainty). In the bevacizumab-based combination therapy vs reRT with/without non-bevacizumab-based systemic therapy group, adding bevacizumab improved PFS (HR 0.46 (95% CI 0.27-0.77); low certainty) and OS (HR 0.42 (95% CI 0.24-0.72; low certainty) and reduced radionecrosis (RR 0.17 (95% CI 0.06-0.48); low certainty).
Combination therapy may improve OS and PFS with acceptable toxicities in patients with rHGG compared to reRT or systemic therapy alone. Particularly, combining bevacizumab with reRT prophylactically reduces radionecrosis.
CRD42022291741.
本综述比较了复发性高级别胶质瘤（rHGG）患者的再放疗（reRT）、系统治疗和联合治疗（reRT 和系统治疗）在总生存期（OS）、无进展生存期（PFS）、不良事件（AEs）和生活质量（QoL）方面的疗效。
我们在 PubMed、Scopus、Embase 和 CENTRAL 上进行了检索。纳入了报告 OS、PFS、AEs 和/或 QoL 并包含以下组别的研究：再放疗与系统治疗比较、联合治疗与系统治疗比较、联合治疗与 reRT 比较、贝伐珠单抗联合治疗与 reRT 加/不加非贝伐珠单抗系统治疗比较。使用随机效应模型进行了荟萃分析。使用 GRADE 评估证据确定性。
纳入了 31 项研究（3 项随机、28 项非随机），共 2084 名参与者。在联合治疗与系统治疗组，联合治疗改善了 PFS（HR 0.57（95%CI 0.41-0.79）；低确定性）和 OS（HR 0.73（95%CI 0.56-0.95）；低确定性），并且 3 级+AEs 无差异（RR 1.03（95%CI 0.57-1.86）；非常低确定性）。在联合治疗与 reRT 组，联合治疗改善了 PFS（HR 0.52（95%CI 0.38-0.72）；低确定性）和 OS（HR 0.69（95%CI 0.52-0.93）；低确定性）。在贝伐珠单抗联合治疗与 reRT 加/不加非贝伐珠单抗系统治疗组，添加贝伐珠单抗改善了 PFS（HR 0.46（95%CI 0.27-0.77）；低确定性）和 OS（HR 0.42（95%CI 0.24-0.72；低确定性），并降低了放射性坏死（RR 0.17（95%CI 0.06-0.48）；低确定性）。
与单独 reRT 或系统治疗相比，联合治疗可能改善 rHGG 患者的 OS 和 PFS，且毒性可接受。特别是，预防性联合贝伐珠单抗和 reRT 可降低放射性坏死的风险。
CRD42022291741。
