Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33806
Title: Reirradiation versus systemic therapy versus combination therapy for recurrent high-grade glioma: a systematic review and meta-analysis of survival and toxicity.
Austin Authors: Marwah, Ravi;Xing, Daniel T ;Squire, Timothy;Soon, Yu Yang;Gan, Hui K ;Ng, Sweet Ping 
Affiliation: Department of Radiation Oncology, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia.;College of Medicine and Dentistry, James Cook University, Townsville, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Australia.
Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore.
Medical Oncology
Olivia Newton-John Cancer Wellness and Research Centre
Issue Date: 21-Sep-2023
Date: 2023
Publication information: Journal of Neuro-oncology 2023-09-21;164(3)
Abstract: 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). 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. 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). 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. CRD42022291741.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33806
DOI: 10.1007/s11060-023-04441-0
ORCID: 
Journal: Journal of Neuro-oncology
PubMed URL: 37733174
ISSN: 1573-7373
Type: Journal Article
Subjects: Combination therapy
High-grade glioma
Recurrent
Reirradiation
Systemic therapy
Appears in Collections:Journal articles

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