PMID- 37733174
OWN - NLM
STAT- MEDLINE
DCOM- 20231106
LR  - 20231106
IS  - 1573-7373 (Electronic)
IS  - 0167-594X (Print)
IS  - 0167-594X (Linking)
VI  - 164
IP  - 3
DP  - 2023 Sep
TI  - Reirradiation versus systemic therapy versus combination therapy for recurrent 
      high-grade glioma: a systematic review and meta-analysis of survival and 
      toxicity.
PG  - 505-524
LID - 10.1007/s11060-023-04441-0 [doi]
AB  - PURPOSE: This review compares reirradiation (reRT), systemic therapy and 
      combination therapy (reRT & systemic therapy) with regards to overall survival 
      (OS), progression-free survival (PFS), adverse effects (AEs) and quality of life 
      (QoL) in patients with recurrent high-grade glioma (rHGG). METHODS: A search was 
      performed on PubMed, Scopus, Embase and CENTRAL. Studies reporting OS, PFS, AEs 
      and/or QoL and encompassing the following groups were included; reirradiation vs 
      systemic therapy, combination therapy vs systemic therapy, combination therapy vs 
      reRT, and bevacizumab-based combination therapy vs reRT with/without 
      non-bevacizumab-based systemic therapy. Meta-analyses were performed utilising a 
      random effects model. Certainty of evidence was assessed using GRADE. RESULTS: 
      Thirty-one studies (three randomised, twenty-eight non-randomised) comprising 
      2084 participants were included. In the combination therapy vs systemic therapy 
      group, combination therapy improved PFS (HR 0.57 (95% CI 0.41-0.79); low 
      certainty) and OS (HR 0.73 (95% CI 0.56-0.95); low certainty) and there was no 
      difference in grade 3 + AEs (RR 1.03 (95% CI 0.57-1.86); very low certainty). In 
      the combination therapy vs reRT group, combination therapy improved PFS (HR 0.52 
      (95% CI 0.38-0.72); low certainty) and OS (HR 0.69 (95% CI 0.52-0.93); low 
      certainty). In the bevacizumab-based combination therapy vs reRT with/without 
      non-bevacizumab-based systemic therapy group, adding bevacizumab improved PFS (HR 
      0.46 (95% CI 0.27-0.77); low certainty) and OS (HR 0.42 (95% CI 0.24-0.72; low 
      certainty) and reduced radionecrosis (RR 0.17 (95% CI 0.06-0.48); low certainty). 
      CONCLUSIONS: Combination therapy may improve OS and PFS with acceptable 
      toxicities in patients with rHGG compared to reRT or systemic therapy alone. 
      Particularly, combining bevacizumab with reRT prophylactically reduces 
      radionecrosis. REGISTRATION: CRD42022291741.
CI  - (c) 2023. Crown.
FAU - Marwah, Ravi
AU  - Marwah R
AD  - Department of Radiation Oncology, Townsville University Hospital, 100 Angus Smith 
      Drive, Douglas, Townsville, QLD, 4814, Australia. ravi.marwah@health.qld.gov.au.
AD  - College of Medicine and Dentistry, James Cook University, Townsville, Australia. 
      ravi.marwah@health.qld.gov.au.
FAU - Xing, Daniel
AU  - Xing D
AD  - Department of Radiation Oncology, Townsville University Hospital, 100 Angus Smith 
      Drive, Douglas, Townsville, QLD, 4814, Australia.
AD  - College of Medicine and Dentistry, James Cook University, Townsville, Australia.
FAU - Squire, Timothy
AU  - Squire T
AD  - Department of Radiation Oncology, Townsville University Hospital, 100 Angus Smith 
      Drive, Douglas, Townsville, QLD, 4814, Australia.
AD  - College of Medicine and Dentistry, James Cook University, Townsville, Australia.
FAU - Soon, Yu Yang
AU  - Soon YY
AD  - Department of Radiation Oncology, National University Cancer Institute, 
      Singapore, Singapore.
FAU - Gan, Hui K
AU  - Gan HK
AD  - Department of Medical Oncology, Olivia Newton-John Cancer Wellness & Research 
      Centre, Austin Health, Melbourne, Australia.
AD  - Cancer Therapies and Biology Group, Centre of Research Excellence in Brain 
      Tumours, Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, 
      Melbourne, Australia.
FAU - Ng, Sweet Ping
AU  - Ng SP
AD  - Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research 
      Centre, Austin Health, Melbourne, Australia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230921
PL  - United States
TA  - J Neurooncol
JT  - Journal of neuro-oncology
JID - 8309335
RN  - 2S9ZZM9Q9V (Bevacizumab)
SB  - IM
MH  - Humans
MH  - Bevacizumab/therapeutic use
MH  - Quality of Life
MH  - *Re-Irradiation/adverse effects
MH  - Neoplasm Recurrence, Local/drug therapy/radiotherapy
MH  - *Glioma/drug therapy/radiotherapy
MH  - Randomized Controlled Trials as Topic
PMC - PMC10589175
OTO - NOTNLM
OT  - Combination therapy
OT  - High-grade glioma
OT  - Recurrent
OT  - Reirradiation
OT  - Systemic therapy
COIS- The authors have no relevant financial or non-financial interests to disclose.
EDAT- 2023/09/21 12:43
MHDA- 2023/11/06 06:41
PMCR- 2023/09/21
CRDT- 2023/09/21 11:12
PHST- 2023/07/30 00:00 [received]
PHST- 2023/08/28 00:00 [accepted]
PHST- 2023/11/06 06:41 [medline]
PHST- 2023/09/21 12:43 [pubmed]
PHST- 2023/09/21 11:12 [entrez]
PHST- 2023/09/21 00:00 [pmc-release]
AID - 10.1007/s11060-023-04441-0 [pii]
AID - 4441 [pii]
AID - 10.1007/s11060-023-04441-0 [doi]
PST - ppublish
SO  - J Neurooncol. 2023 Sep;164(3):505-524. doi: 10.1007/s11060-023-04441-0. Epub 2023 
      Sep 21.