Radiotherapy Combined With Temozolomide And Radiotherapy Alone In Elderly Glioblastoma Patients:A Systematic Evidence-based Analysis

Objective:Although current treatment advances prolong patient survival,treatment for glioblastoma(GBM)elderly has become an emerging issue.The definition of “elderly” differs across articles,GBM predominantly occurs at an age ?65 years,and the prognosis worsens with increasing age.The elderly account for a large proportion of patients diagnosed with glioblastoma(GBM),As the population ages,the population of elderly patients with glioblastoma has increased.Most clinical trials have excluded patients with glioblastoma elderly,and current treatment options for elderly patients with GBM are still controversial.We conducted a systematic evidence-based analysis to provide a reference for the treatment of elderly patients with GBM.Evidence for radiation therapy(RT)and temozolomide(TMZ)combination therapy for elderly patients aged ?65 years.Methods: A systematic literature search was performed using PubMed,EMBASE and Cochrane Library electronic databases.Theincluded literature was rigorously evaluated according to the Newcastle-Ottawa Scale(NOS),and the statistical software was Revman5.3.the combined RT/TMZ and RT alone was compared to the efficacy of newly diagnosed elderly GBM patients.A total of 11 eligible articles were found: 1 randomized controlled trial(RCT)and 10 non-randomized controlled trials(NRSs),all of which were retrospective studies.All 11 literatures compared overall survival period,and 6 literatures compared progression-free survival period.7 articles compared the effects of surgical and non-surgical treatment on patient survival.4 literatures compares the influence of MGMT promoter methylation on patient survival.There were no control groups for Karnofsky performance status(KPS)scores and adverse reactions,by descripting analysis data.There is only 1 RCT mentioned in the quality of life.There was some heterogeneity in OS,but the results have not changed significantly through subgroup analysis.The sensitive analysis did not show any significant change.Results: RT/TMZ Combined treatment was shown to reduce the risk of death and progression in elderly GBM patients compared with RT alone,OS hazard ratio: [HR=0.64,95% CI(0.61-0.68),P<0.00001];PFS hazard ratio: [HR = 0.60,95% CI(0.46-0.79),P < 0.0002].Compared with non-surgical treatment(biopsy only),surgical treatment provides better survival benefit for elderly patients compared with non-surgicaltreatment [HR=0.57,95% CI(0.50,0.64),P<0.00001].Whether the MGMT promoter methylation in elderly GBM patients had no statistical significance for the overall survival of patients [OR=0.66,95% CI(0.26,1.70)),P = 0.39].Conclusions:Elderly GBM patients can benefit from RT/TMZ combination therapy.Surgery is an independent factor affecting the survival of elderly GBM patients.Adverse reactions are still acceptable in elderly GBM patients receiving RT/TMZ combination therapy.and more clinical randomized controlled trials are warrnted to determine the best treatment for elderly GBM.