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Effectiveness and safety of different postoperative adjuvant regimens in patients with low-grade gliomas:A network meta-analysis

World Neurosurg. 2023 Sep 4:S1878-8750(23)01237-8. doi: 10.1016/j.wneu.2023.08.125. Online ahead of print.


OBJECTIVES: This study aimed to investigate the effectiveness and safety of various adjuvant regimens in patients with low-grade gliomas, and to further explore the optimal adjuvant treatment for patients with low-grade gliomas and the differences in the efficacy of each treatment regimens in different tumor types.

METHODS: A comprehensive search of the PubMed, Cochrane Library, Ovid, Embase, and Web of Science databases was conducted to screen randomized and nonrandomized controlled trials related to adjuvant therapy in patients with low-grade gliomas. The Cochrane quality assessment method and the Newcastle-Ottawa scale were used to assess the quality of the included randomized and nonrandomized controlled trials, respectively. The data from previous studies were extracted using Excel and GetData Graph Digitizer 2.26 software, and network meta-analysis was performed using RevMan 5.3 and Stata 16.0 statistical software.

RESULTS: The specific ranking of 5-year progression-free survival (PFS) for each treatment regimen from best to the worst in patients with low-grade gliomas was surgery combined with procarbazine, lomustine, and vincristine (S + PCV), surgery combined with standard radiotherapy and PVC multidrug chemotherapy (S + RT + PCV), surgery combined with standard radiotherapy and temozolomide monotherapy (S + RT + TMZ), surgery combined with enhanced radiotherapy (S + H-RT), surgery combined with standard radiotherapy (S + RT), surgery combined with TMZ (S + TMZ), and S. The 5-year overall survival (OS) ranking was S + RT + TMZ, S + RT + PCV, S + H-RT + TMZ, S + H-RT, S + RT, and S. The 2-year PFS ranking was S + RT + TMZ, S + PCV, S + RT, S + RT + PCV, S + TMZ, S + H -RT, and S. The 2-year OS ranking was S + RT + TMZ, S + H-RT + TMZ, S + RT, S + RT + PCV, S + H – RT, and S. The incidence of adverse events (AEs ≥ 3) was ranked from highest to lowest as follows: S + RT + PCV, S + RT + TMZ, S + PCV, S + H-RT, S + TMZ, and S + RT. In the IDHmt/noncoder group, the S + RT + PCV and S + H – RT regimens had better 5-year PFS and 5-year OS. In the IDHmt/coder group, the 5-year PFS of each treatment regimen ranked from the best to the worst was S + RT + TMZ, S + RT + PCV, S + H-RT, S + RT, S + TMZ, and S. The order of 5-year OS from best to worst was S + H-RT, S + RT + TMZ, S + RT + PCV, S + RT, and S. In the IDHwt group, the S + H-RT and S + TMZ regimens had better 5-year PFS.

CONCLUSIONS: This study revealed that both the S + RT + TMZ and S + RT + PCV regimens might be effective therapies for treating patients with low-grade gliomas. Among these, the S + RT + TMZ regimen seemed to be safer, but might lead to tumor deterioration. In the IDHmt/coder type, the S + RT + TMZ scheme might have a significant advantage. In the IDHmt/noncoder type, the S + RT + PCV scheme might be more dominant, while in the IDHwt type, the S + H – RT and S + TMZ schemes also might be good treatment options.

PMID:37673325 | DOI:10.1016/j.wneu.2023.08.125

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