Article type
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Abstract
Background: Randomised trials of chemotherapy in high-grade glioma frequently have small numbers of patients and have shown inconclusive or conflicting results. There is no real consensus on whether chemotherapy improves survival, an international collaborative meta-analysis was therefore initiated. Objectives: To carry out an individual patient data (IPD) systematic review and meta-analysis to assess the role of chemotherapy in the treatment of high-grade glioma in adult patients and to investigate whether any pre-defined patient subgroup benefits more or less from chemotherapy
Methods: IPD were obtained from 10 RCTs comparing radiotherapy alone with radiotherapy plus chemotherapy, mostly nitrosoureas either alone or in combination. The meta-analysis included 2368 patients and 2106 deaths. Data were combined using the stratified (by trial) log rank test to calculate pooled hazard ratios (HRs). Absolute differences were calculated from each HR and the corresponding control group event rate at 2 years.
Results : Endpoint HR (95% CI) Absolute Difference At 2 years p-value Survival 0.84 (0.77-0.92) 5% (from 15 to 20%) 0.0001 Recurrence-free survival 0.80(0.72-0.90) 6% (from 10 to 16%) 0.00008 The results show a significant benefit of chemotherapy with a 16% relative reduction in the risk of death. This is equivalent to an absolute improvement of 5% at 2 years (95% confidence interval 3 to 9%) increasing the survival rate from 15% to 20%. There was no evidence that the effect of chemotherapy was different in any group of patients defined by age, sex, histology, performance status or extent of resection.
Discussion: This small but clear improvement in survival from chemotherapy encourages further study of systemic treatment of these tumours. Presented on behalf of the Glioma Meta-analysis Trialists Group.
Methods: IPD were obtained from 10 RCTs comparing radiotherapy alone with radiotherapy plus chemotherapy, mostly nitrosoureas either alone or in combination. The meta-analysis included 2368 patients and 2106 deaths. Data were combined using the stratified (by trial) log rank test to calculate pooled hazard ratios (HRs). Absolute differences were calculated from each HR and the corresponding control group event rate at 2 years.
Results : Endpoint HR (95% CI) Absolute Difference At 2 years p-value Survival 0.84 (0.77-0.92) 5% (from 15 to 20%) 0.0001 Recurrence-free survival 0.80(0.72-0.90) 6% (from 10 to 16%) 0.00008 The results show a significant benefit of chemotherapy with a 16% relative reduction in the risk of death. This is equivalent to an absolute improvement of 5% at 2 years (95% confidence interval 3 to 9%) increasing the survival rate from 15% to 20%. There was no evidence that the effect of chemotherapy was different in any group of patients defined by age, sex, histology, performance status or extent of resection.
Discussion: This small but clear improvement in survival from chemotherapy encourages further study of systemic treatment of these tumours. Presented on behalf of the Glioma Meta-analysis Trialists Group.