Abstract：
OBJECTIVE: Evidence and clinical guidelines support the use of adjuvant RT in high-risk low-grade gliomas. However, patients with oligodendroglioma have a more indolent disease course and delaying or avoiding RT is often considered to reduce treatment-related toxicities. As the optimal adjuvant management for oligodendroglioma is unclear, we aimed to assess the effect of adjuvant RT on overall survival (OS) and progression-free survival (PFS).
METHODS: MEDLINE, EMBASE, CENTRAL and CINAHL were searched from January 1990 to February 2023 for studies comparing adjuvant RT versus no adjuvant RT for patients with oligodendroglioma.
RESULTS: This review found 17 eligible studies including 14 comparative retrospective studies and 3 randomized controlled trials. Using random-effects model, the results suggested that adjuvant RT improved OS by 28 % (HR 0.72, 95 % CI (0.56-0.93), I2 = 86 %), and PFS by 48 % (HR 0.52, (95 % CI 0.40-0.66), I2 = 48 %) compared to patients without adjuvant RT. Subgroup analysis showed that upfront adjuvant RT improved OS and PFS compared to salvage RT. There were no significant differences in OS and PFS between adjuvant RT versus adjuvant chemotherapy. There was improvement in PFS but not OS for adjuvant chemoradiotherapy versus adjuvant chemotherapy alone. Adjuvant RT improved OS in WHO Grade 3 but not WHO Grade 2 oligodendroglioma.
CONCLUSIONS: Overall, adjuvant RT improved OS and PFS in patients with oligodendroglioma. In patients with low-risk features (e.g. Grade 2, gross total resection), alternative approaches and individualization of management such as adjuvant chemotherapy alone may be reasonable considering the lack of survival benefit. Future efforts should prospectively investigate these treatment regimens on molecularly-classified oligodendroglioma patients (defined by presence of IDH mutation and 1p/19q co-deletion), balancing between maximizing survival outcomes and reducing RT-related toxicities.
METHODS: MEDLINE, EMBASE, CENTRAL and CINAHL were searched from January 1990 to February 2023 for studies comparing adjuvant RT versus no adjuvant RT for patients with oligodendroglioma.
RESULTS: This review found 17 eligible studies including 14 comparative retrospective studies and 3 randomized controlled trials. Using random-effects model, the results suggested that adjuvant RT improved OS by 28 % (HR 0.72, 95 % CI (0.56-0.93), I2 = 86 %), and PFS by 48 % (HR 0.52, (95 % CI 0.40-0.66), I2 = 48 %) compared to patients without adjuvant RT. Subgroup analysis showed that upfront adjuvant RT improved OS and PFS compared to salvage RT. There were no significant differences in OS and PFS between adjuvant RT versus adjuvant chemotherapy. There was improvement in PFS but not OS for adjuvant chemoradiotherapy versus adjuvant chemotherapy alone. Adjuvant RT improved OS in WHO Grade 3 but not WHO Grade 2 oligodendroglioma.
CONCLUSIONS: Overall, adjuvant RT improved OS and PFS in patients with oligodendroglioma. In patients with low-risk features (e.g. Grade 2, gross total resection), alternative approaches and individualization of management such as adjuvant chemotherapy alone may be reasonable considering the lack of survival benefit. Future efforts should prospectively investigate these treatment regimens on molecularly-classified oligodendroglioma patients (defined by presence of IDH mutation and 1p/19q co-deletion), balancing between maximizing survival outcomes and reducing RT-related toxicities.
摘要：
目的：证据和临床指南支持在高风险低度胶质瘤中使用辅助放疗。然而,少突胶质细胞瘤患者的病程较为缓慢,延迟或避免RT常被认为可降低治疗相关毒性.由于少突胶质细胞瘤的最佳辅助治疗尚不清楚，我们旨在评估辅助RT对总生存期(OS)和无进展生存期(PFS)的影响.
方法：MEDLINE，EMBASE,从1990年1月至2023年2月，对CENTRAL和CINAHL进行了研究，以比较少突胶质细胞瘤患者的辅助RT和无辅助RT。
结果：本综述发现了17项符合条件的研究，包括14项比较回顾性研究和3项随机对照试验。使用随机效应模型，结果表明，佐剂RT将OS提高了28%(HR0.72，95%CI(0.56-0.93)，I2=86%），和PFS增加48%(HR0.52，(95%CI0.40-0.66)，I2=48%)与没有辅助RT的患者相比。亚组分析显示，与挽救性RT相比，前期佐剂RT改善了OS和PFS。辅助RT与辅助化疗在OS和PFS方面无显著差异。辅助放化疗与单纯辅助化疗相比，PFS有改善，但OS没有改善。辅助RT改善了WHO3级而非WHO2级少突胶质细胞瘤的OS。
结论：总体而言，辅助RT可改善少突胶质细胞瘤患者的OS和PFS。在具有低风险特征（例如2级，总切除）的患者中，考虑到缺乏生存获益,替代方法和个体化管理,如单独辅助化疗可能是合理的.未来的努力应该前瞻性地研究这些治疗方案对分子分类的少突胶质细胞瘤患者（定义为存在IDH突变和1p/19q共缺失），在最大化生存结果和减少RT相关毒性之间取得平衡。
方法：MEDLINE，EMBASE,从1990年1月至2023年2月，对CENTRAL和CINAHL进行了研究，以比较少突胶质细胞瘤患者的辅助RT和无辅助RT。
结果：本综述发现了17项符合条件的研究，包括14项比较回顾性研究和3项随机对照试验。使用随机效应模型，结果表明，佐剂RT将OS提高了28%(HR0.72，95%CI(0.56-0.93)，I2=86%），和PFS增加48%(HR0.52，(95%CI0.40-0.66)，I2=48%)与没有辅助RT的患者相比。亚组分析显示，与挽救性RT相比，前期佐剂RT改善了OS和PFS。辅助RT与辅助化疗在OS和PFS方面无显著差异。辅助放化疗与单纯辅助化疗相比，PFS有改善，但OS没有改善。辅助RT改善了WHO3级而非WHO2级少突胶质细胞瘤的OS。
结论：总体而言，辅助RT可改善少突胶质细胞瘤患者的OS和PFS。在具有低风险特征（例如2级，总切除）的患者中，考虑到缺乏生存获益,替代方法和个体化管理,如单独辅助化疗可能是合理的.未来的努力应该前瞻性地研究这些治疗方案对分子分类的少突胶质细胞瘤患者（定义为存在IDH突变和1p/19q共缺失），在最大化生存结果和减少RT相关毒性之间取得平衡。
