Temozolomide Combined with Radiotherapy Can Benefit Patients with Glioma: A Systematic Review and Meta-Analysis

Abstract Background: Glioma originates from glial cells of the nervous system and is the most common malignant tumor in the brain. Temozolomide is considered as a promising medicine that can improve the overall survival (OS) and progress-free survival (PFS) rate of patients with glioma after operation. However, whether radiotherapy plus temozolomide has substantive role for glioma patients remains controversial. Methods:We conducted a meta-analysis included 10 Randomized controlled trials (RCTs) encompassing 2703 patients to evaluate the efficacy and safety of radiotherapy plus temozolomide for glioma. EMbase, PubMed, Web of Science, and Cochrane library were searched. Our study strictly follows the PRISMA guideline. Results:Overall, compared with receiving radiotherapy alone, patients through radiotherapy combined with temozolomide has substantial benefit on both OS (HR=0.78; 95% CI: 0.62-0.98; P =0.03) and PFS (HR=0.62; 95% CI: 0.49-0.78; P <0.0001). The best effect shows in patients receiving radiotherapy combined with both concurrent and adjuvant temozolomide on both OS (HR=0.66; 95% CI: 0.58-0.74; P <0.00001) and PFS (HR=0.55; 95% CI: 0.48-0.62; P <0.00001), when compared with radiotherapy alone. Whereas, temozolomide monotherapy do not show greater benefits than radiotherapy alone on OS (HR=0.93; 95% CI: 0.74-1.14; P =0.53). Moreover, radiotherapy plus temozolomide obviously increase the incidence of hematological complications than only radiotherapy (RR=10.31; 95% CI: 4.49-23.71; P<0.00001). Also, our meta-analysis suggested that MGMT methylation test can be helpful for evaluating prognosis, determining individualized treatment and forecasting the curative effect. Conclusion:Radiotherapy combined with temozolomide, especially combined with both concurrent and adjuvant temozolomide has great benefit on both OS and PFS of glioma patients. Conditionally, patients with glioma receiving glioma MGMT methylation test have advantage over evaluating prognosis, determining individualized treatment and forecasting the curative effect. Last but not least, monitoring blood routine and remedying the possible abnormalities in time is especially necessary of patient receiving temozolomide therapy.