Treatments of gliosarcoma of the brain: a systematic review and meta-analysis
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ORIGINAL ARTICLE
Treatments of gliosarcoma of the brain: a systematic review and meta‑analysis Xing Wang1 · Jiao Jiang2 · Meixi Liu3 · Chao You1,4 Received: 9 June 2020 / Accepted: 20 October 2020 © Belgian Neurological Society 2020
Abstract Gliosarcoma (GSM) is a rare central nervous system tumor. Clinical management of it is similar to glioblastoma (GBM). However, due to a few comparative studies exist, uncertainty and disagreements remain in the literatures. To assess the available evidence on the value of different treatments and to carry out an up-to-date evaluation to summarize the evidence for the optimal treatment in GSM patients. Free words were used to search for the relevant studies without language limitations in electronic databases including PubMed, Ovid EMBASE, Cochrane Central Register of Controlled Trials from inception to September 15, 2019. Pooled hazard ratio (HR) with 95% confidence interval (CI) were calculated using a random-effects model. The main endpoint was all-cause mortality. Overall, 10 studies published between 2008 and 2018 including 803 patients were selected for the meta-analysis. Temozolomide (TMZ)-dominated chemotherapy was associated with a reduced risk of overall survival (OS), with HR 0.49 (95% CI 0.37–0.66). The pooled HR of OS was 0.40 (95% CI 0.29–0.56) between radiotherapy and without radiotherapy. The pooled HR (0.52, 95% CI 0.32–0.85) indicated gross total resection (GTR) had a positive impact on OS in GSM. In patients with GSM, survival benefits as currently performed are associated with TMZdominated chemotherapy and high-dose radiotherapy. Our systematic review and meta-analysis also demonstrate GTR is associated with a reduction in all-cause mortality in patients with primary GSM. Keywords Gliosarcoma · Radiotherapy · TMZ · GTR · Survival
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13760-020-01533-w) contains supplementary material, which is available to authorized users. * Chao You [email protected] 1
Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, St. Guoxuexiang, Chengdu 610041, Sichuan, People’s Republic of China
2
Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha 410008, Hunan, People’s Republic of China
3
Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, People’s Republic of China
4
West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People’s Republic of China
Gliosarcoma (GSM), characterized by a mixture of glial and sarcomatous histopathologic compositions, is a rare but highly malignant glioblastoma (GBM) that accounts for 2–8% of high-grade gliomas (HGG) [1–4]. GSM has gained widespread acceptance gradually since 1955 when Feigen et al. [4] first described. At present, it is generally accepted that the clinical characteristics of GSM are similar to GBM. However, GSM seems to metastasize much more frequently than GBM
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