Meta-analysis About Malignant Glioma: Simultaneous Or Adjuvant Temozolomide And Radiotherapy Alone

Objective: To systematically evaluate the clinical efficacy and security between temozolomide combined with radiotherapy and radiotherapy alone in the treatment of glioma.Methords: Medline, Pubmed, CMCC, Google Scholar, Embase, Ovid,Cochrane, China Academic Journal Full Database (CNKI) and et al were searched from the beginning to march 2010, tracing all the references included in the study, and manually searched relevant meetings of the Education Book and related test references. Searching years were retrieved from the library building in March 2010. Temozolomide combined with radiotherapy and radiotherapy alone compared the clinical efficacy of randomized controlled trials (RCT) were eligible for inclusion. Evaluation of the methodological quality of eligible studies by RevMan 4.2.2 software to Meta-analysis.Results: A total of five randomized controlled trials were included (n=846). Meta analysis showed that the combination group of progression-free survival in first year was superior to radiotherapy alone group (RD with 95% CI, 0.24[0.16, 0.33], P <0.00001), which could improve progression-free survival rate of 24%. The difference was statistically significant. One year survival rate of the combination group was superior to radiotherapy alone group (RD with 95% CI, 0.22[0.04,0.40],P=0.02), which can increase the survival rate of 22%. And the difference was significant. Progression-free survival time of the combination group is superior to radiotherapy alone group (SMD and 95% CI, 0.37 [0.02, 0.71], P = 0.04). The difference was statistically significant. The overall survival time of the combination group is superior to radiotherapy alone group (SMD and 95% CI, 0.28 [-0.04, 0.61], P = 0.09), the difference was not statistically significant. Patients had the side effects in combination group RT + TMZ phase was less than Adjuvant TMZ phase (OR with 95% CI, 0.39 [0.26,0.60], P <0.00001), the difference was statistically significant. Toxicity of the combination group was higher than with radiotherapy alone (OR with 95% CI, 7.34 [1.43, 37.67], P = 0.02), the difference was statistically significant.Conclusions: The available evidence suggests that radiotherapy combined with temozolomide compared with radiotherapy alone, can significantly improve the one year progression-free survival rate, improve survival rate and the overall survival time. We can find the trend of improving in the progression-free survival time. Radiotherapy combined with temozolomide has good security.