The Evidence-based Study Of TMZ Vs Traditional Chemotherapy Drugs To Treatment High Grade Glioma

Objective To compare the effect of temozolomide (TMZ) with traditional chemotherapy drugs for brain glioma patients who had undergone surgery and were then allocated radiotherapy plus chemotherapy. Our research used the Systematic Review (SR) methods to assess the effectiveness and safety of TMZ vs traditional chemotherapy drugs to treat high grade glioma and to classify the evidence in this SR. Based on the systematic review, using the historical cohort way research the two groups and do statistic analysis on the data. This study would provide the evidence of EBM in clinical practice for TMZ vs VM-26+DDP to treat high grade glioma.Methods The literatures of randomized controlled trials comparing temozolomide with traditional chemotherapy drugs for glioma patients were retrieved by searching the national and international databases, such as PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database, Chinese Scientific Journals Full Text Database, China Journal Full Text Database and WanFang Full Text Database from their inception date to Dec2013. Two researchers independently screened literatures according to the predefined inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. In the case of discrepancy during the extraction of the data, consensus decision was achieved by discussion or where necessary adjudicated by the third reviewer. Meta-analysis was performed by using RevMan5.2software. Using the historical cohort way objectively evaluate the curative and untoward effect and economics of TMZ vs VM-26+DDP on glioma. Statistical analyses are performed with SPSS software version19.0.Results A total of8RCTs involving864patients were finally selected, with374cases in TMZ group and490cases in traditional chemotherapy drugs group. The baseline data of each trial were preferably comparable. The results of meta-analyses showed that the therapy effective rate (RR=1.48,95%CI1.24to1.77), five-year survival rate (HR=23.94,95%CI13.26to43.22), the progression-free survival (MD=4.00,95%CI2.61to5.39), the average survival (SMD=1.84,95%CI1.40to2.27) were significantly increased in TMZ group compared with traditional chemotherapy drugs group for the treatment of glioma patients of postoperative radiotherapy (all P<0.05). And alimentary tract reactions (RR=0.53,95%CI0.39to0.71), marrow depression (RR=0.20,95%CI 0.08to0.51) were significantly reduced in TMZ group compared with traditional chemotherapy drugs group for the treatment of glioma patients (all P＜0.05). The historical cohort proved the curative effect and safety have no difference between two groups. Moreover, economic evaluation showed TMZ group costed higher than VP group.Conclusions Compared with traditional chemotherapy drugs, TMZ is safe and reliable with better overall curative effect, less adverse reactions and prolonged survival time for glioma patients of postoperative radiotherapy. Current available evidence demonstrated the curative effect in TMZ and VP is similar, however, TMZ costs higher than VP. Nevertheless, the clinical study used the historical cohort may leave limitations in this study. More perspective study are expected in further.