Hostname: page-component-76dd75c94c-7vt9j Total loading time: 0 Render date: 2024-04-30T07:37:38.079Z Has data issue: false hasContentIssue false
  • English
  • Français

Adjuvant Chemotherapy for Adults with Malignant Glioma: A Systematic Review

Published online by Cambridge University Press:  02 December 2014

James Perry ,
Normand Laperriere ,
Lisa Zuraw ,
Alexandra Chambers ,
Karen Spithoff  and
J. Gregory Cairncross
James Perry
Affiliation:
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
Normand Laperriere
Affiliation:
Princess Margaret Hospital, Toronto, Ontario
Lisa Zuraw
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
Alexandra Chambers
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
Karen Spithoff
Affiliation:
Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton, Ontario
J. Gregory Cairncross
Affiliation:
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

This systematic review examines the role of chemotherapy following surgery and external beam radiotherapy for adults with newly diagnosed malignant glioma.

Methods:

MEDLINE, EMBASE, and the Cochrane Library databases were searched to August 2006 to identify relevant randomized controlled trials (RCTs) and meta-analyses. Proceedings from the 1997 to 2006 annual meetings of the American Society of Clinical Oncology were also searched.

Results:

Two RCTs reported a survival advantage in favour of radiotherapy with concomitant and adjuvant temozolomide compared with radiotherapy alone in patients with anaplastic astrocytoma or glioblastoma. Twenty-six RCTs and two meta-analyses detected either no advantage or a small survival advantage in favour of adjuvant chemotherapy.

Conclusion:

Concomitant temozolomide during radiotherapy and post-radiation adjuvant temozolomide is recommended for all patients ages 18-70 with newly diagnosed glioblastoma multiforme who are fit for radical therapy (ECOG 0-1). Temozolomide may be considered in other situations (i.e., ECOG 2, biopsy only, age >70, intermediate grade glioma), but there is no high-level evidence to support this decision. Moreover, there are few data on long-term toxicities or quality of life with temozolomide. Adjuvant chemotherapy may be an option for younger patients with anaplastic (grade 3) astrocytoma and patients with pure or mixed oligodendroglioma. However, there is no evidence of a survival advantage from adjuvant chemotherapy in these patients, and treatment-related adverse effects and their impact upon quality of life are poorly studied. The combination of procarbazine, lomustine, and vincristine (PCV) is not recommended for patients with anaplastic oligodendroglioma and oligoastrocytoma.

Résumé:

RÉSUMÉ:<span class='italic'><span class='bold'>Objectif</span></span>:

Cette revue systématique examine le rôle de la chimiothérapie administrée après la chirurgie et la radiothérapie externe chez les adultes porteurs d’un gliome malin dont le diagnostic est récent.

<span class='italic'><span class='bold'>Méthodes</span></span>:

Nous avons identifié les essais contrôlés randomisés (ECRs) pertinents ainsi que les méta-analyses dans les bases de données MEDLINE, EMBASE et la Cochrane Library jusqu’en août 2006. Nous avons également révisé les comptes rendus des réunions annuelles de l’American Society of Clinical Oncology.

<span class='italic'><span class='bold'>Résultats</span></span>:

Deux ECRs ont rapporté un bénéfice quant à la survie avec le témozolomide comme traitement adjuvant administré en même temps que la radiothérapie par rapport à la radiothérapie seule chez des patients porteurs d’un astrocytome anaplasique ou d’un glioblastome. Vingt-six ECRs et deux méta-analyses n’ont pas mis en évidence d’avantage ou ont démontré un faible avantage quant à la survie avec la chimiothérapie adjuvante.

<span class='italic'><span class='bold'>Conclusion</span></span>:

L’administration de témozolomide pendant la radiothérapie et son administration adjuvante après l’irradiation est recommandée chez tous les patients entre 18 et 70 ans chez qui on vient de poser un diagnostic de glioblastome multiforme et dont l’état général le permet (ECOG 0-1). On peut envisager le traitement par le témozolomide dans d’autres situations (c’est-à-dire ECOG 2, biopsie seulement, âge < 70 ans, gliome de grade intermédiaire), mais il n’existe pas de données probantes à cet effet. De plus, il existe peu de données sur la toxicité à long terme du témozolomide ou sur la qualité de vie. La chimiothérapie adjuvante peut être une option chez les patients plus jeunes qui sont porteurs d’un astrocytome anaplasique (grade 3) et les patients porteurs d’un oligodendrogliome pure ou mixte. Cependant, un avantage quant à la survie n’a pas été démontré avec l’administration de la chimiothérapie adjuvante chez ces patients et les effets secondaires et leur impact sur la qualité de vie ont été mal étudiés. La combinaison procarbazine, lomustine et vincristine (PCV) n’est pas recommandée chez les patients porteurs d’un oligodendrogliome ou d’un oligoastrocytome anaplasique.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 402 - 410
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Mason, W, Louis, DN, Cairncross, JG. Chemosensitive gliomas in adults: which ones and why? J Clin Oncol. 1997;15:3423–6.Google Scholar
2. Perry, JR, DeAngelis, LM, Schold, SC Jr, Burger, PC, Brem, H, Brown, MT, et al. Challenges in the design and conduct of phase III brain tumor therapy trials. Neurology. 1997;49:912–7.Google Scholar
3. Browman, GP, Levine, MN, Mohide, EA, Hayward, RS, Pritchard, KI, Gafni, A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol. 1995;13:502–12.Google Scholar
4. Stewart, LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359:1011–18.Google ScholarPubMed
5. Fine, HA, Dear, KB, Loeffler, JS, Black, PM, Canellos, GP. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993;71:2585–97.Google Scholar
6. Edland, RW, Javid, M, Ansfield, FJ. Glioblastoma multiforme. An analysis of the results of postoperative radiotherapy alone versus radiotherapy and concomitant 5-fluorouracil. (A prospective randomized study of 32 cases). Am J Roentgenol Radium Ther Nucl Med. 1971;111:337–42.Google Scholar
7. Brisman, R, Housepian, EM, Chang, C, Duffy, P, Balis, E. Adjuvant nitrosourea therapy for glioblastoma. Arch Neurol. 1976;33:745–50.Google Scholar
8. Reagan, TJ, Bisel, HF, Childs, DS, Layton, DD, Rhoton, AL, Taylor, WF. Controlled study of CCNU and radiation therapy in malignant astrocytoma. J Neurosurg. 1976;44:186–90.Google Scholar
9. Weir, B, Band, P, Urtasun, R, Blain, G, McLean, D, Wilson, F, et al. Radiotherapy and CCNU in the treatment of high-grade supratentorial astrocytomas [abstract]. J Neurosurg. 1976;45:129–34.CrossRefGoogle ScholarPubMed
10. Garrett, MJ, Hughes, HJ, Freedman, LS. A comparison of radiotherapy alone with radiotherapy and CCNU in cerebral glioma. Clin Oncol. 1978;4:71–6.Google ScholarPubMed
11. Walker, MD, Alexander, E Jr, Hunt, WE, MacCarty, CS, Mahaley, MS Jr, Mealey, J Jr, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978;49:333–43.Google Scholar
12. E.O.R.T.C. Brain Tumor Group. Effect of CCNU on survival rate of objective remission and duration of free interval in patients with malignant brain glioma-final evaluation. Eur J Cancer. 1978;14:851–6.Google Scholar
13. Eagan, RT, Childs, DS Jr, Layton, DD, Laws, ER Jr, Bisel, HF, Holbrook, MA, et al. Dianhydrogalactitol and radiation therapy. Treatment of supratentorial glioma. JAMA. 1979;241:2046–50.Google Scholar
14. Solero, CL, Monfardini, S, Brambilla, C, Vaghi, A, Valagussa, P, Mrello, G, et al. Controlled study with BCNU vs. CCNU as adjuvant chemotherapy following surgery plus radiotherapy for glioblastoma multiforme. Cancer Clin Trials. 1979;2:43–8.Google Scholar
15. Cianfriglia, F, Pompili, A, Riccio, A, Grassi, A. CCNU-chemotherapy of hemispheric supratentorial glioblastoma multiforme. Cancer. 1980;45:1289–99.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
16. Walker, MD, Green, SB, Byar, DP, Alexander, E Jr, Batzdorf, U, Brooks, WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303:1323–9.CrossRefGoogle ScholarPubMed
17. European Organization for Research on Treatment of Cancer (EORTC) Brain Tumor Group. Evaluation of CCNU, VM-26 plus CCNU, and procarbazine in supratentorial brain gliomas. Final evaluation of a randomized study. J Neurosurg. 1981;55:27–31.Google Scholar
18. Kristiansen, K, Hagen, S, Kollevold, T, Torvik, A, Holme, I, Nesbakken, R, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer. 1981;47:649–52.Google Scholar
19. Chin, HW, Young, AB, Maruyama, Y. Survival response of malignant gliomas to radiotherapy with or without BCNU or methyl-CCNU chemotherapy at the University of Kentucky Medical Center. Cancer Treat Rep. 1981;65:45–51.Google ScholarPubMed
20. Green, SB, Byar, DP, Walker, MD, Pistenmaa, DA, Alexander, E Jr, Batzdorf, U, et al. Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep. 1983;67:121–32.Google Scholar
21. Afra, D, Kocsis, B, Dobay, J, Eckhardt, S. Combined radiotherapy and chemotherapy with dibromodulcitol and CCNU in the postoperative treatment of malignant gliomas. J Neurosurg. 1983; 59:106–10.CrossRefGoogle ScholarPubMed
22. Ushio, Y, Hayakawa, T, Hasegawa, H, Yamada, K, Arita, N. Chemotherapy of malignant gliomas. Neurosurg Rev. 1984;7:3–12.CrossRefGoogle ScholarPubMed
23. Hatlevoll, R, Lindegaard, KF, Hagen, S, Kristiansen, K, Nesbakken, R, Torvik, A, et al. Combined modality treatment of operated astrocytomas grade 3 and 4. A prospective and randomized study of misonidazole and radiotherapy with two different radiation schedules and subsequent CCNU chemotherapy. Stage II of a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer. 1985;56:41–7.Google Scholar
24. Takakura, K, Abe, H, Tanaka, R, Kitamura, K, Miwa, T, Takeuchi, K, et al. Effects of ACNU and radiotherapy on malignant glioma. J Neurosurg. 1986;64:53–7.Google Scholar
25. Nelson, DF, Diener-West, M, Horton, J, Chang, CH, Schoenfeld, D, Nelson, JS. Combined modality approach to treatment of malignant gliomas-re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: a joint study of the Radiation Therapy Oncology Group and the Eastern Cooperative Oncology Group. NCI Monogr. 1988;279-84.Google Scholar
26. Trojanowski, T, Peszynski, J, Turowski, K, Kaminski, S, Goscinski, I, Reinfus, M, et al. Postoperative radiotherapy and radiotherapy combined with CCNU chemotherapy for treatment of brain gliomas. J Neurooncol. 1988;6:285–91.Google Scholar
27. EORTC Brain Tumor Group. Cisplatin does not enhance the effect of radiation therapy in malignant gliomas. Eur J Cancer. 1991;27:568–71.Google Scholar
28. EORTC Brain Tumor Group. Hildebrand, J, Sahmoud, T, Mignolet, F, Brucher, JM, Afra, D. Adjuvant therapy with dibromodulcitol and BCNU increases survival of adults with malignant gliomas. Neurology. 1994;44:1479–83.Google Scholar
29. Medical Research Council Brain Tumor Working Party. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. J Clin Oncol. 2001;19:509–18.CrossRefGoogle Scholar
30. Stupp, R, Mason, WP, van den Bent, MJ, Weller, M, Fisher, B, Taphoorn, MJB, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.Google Scholar
31. Athanassiou, H, Synodinou, M, Maragoudakis, E, Paraskevaidis, M, Verigos, C, Misailidou, D, et al. Randomized phase II study of temozolomide and radiotherapy compared with radiotherapy alone in newly diagnosed glioblastoma multiforme. J Clin Oncol. 2005;23:2372–7.Google Scholar
32. van den Bent, MJ, Carpentier, AF, Brandes, AA, Sanson, M, Taphoorn, MJB, Bernsen, HJJA, et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: A randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. 2006;24:2715–22.Google Scholar
33. Cairncross, G, Berkey, B, Shaw, E, Jenkins, R, Scheithauer, B, Brachman, D, et al. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol. 2006;24:2707–14.Google Scholar
34. Taphoorn, MJB, Stupp, R, Coens, C, Osoba, D, Kortmann, R, van den Bent, MJ, et al. Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol. 2005;6:937–44.Google Scholar
35. Curran, WJ Jr., Scott, CB, Horton, J, Nelson, JS, Weinstein, AS, Fischbach, AJ, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Nat Cancer Inst. 1993;85:704–10.Google Scholar
36. Cairncross, JG, Ueki, K, Zlatescu, MC, Lisle, DK, Finkelstein, DM, Hammond, RR, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst. 1998;90:1473–9.Google Scholar
37. Hegi, ME, Diserens, A, Gorlia, T, Hamou, M, de Tribolet, N, Weller, M, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005;352:997–1003.Google Scholar