Malignant gliomas are among the most devastating of cancers. They frequently result in profound and progressive disability, which often leads to death. Average survival time is only around nine months, with a two-year survival of around 5-10%. Conventional treatment includes resection and radiotherapy; previous studies about the effect of systemic chemotherapy on survival and recurrence in adult patients with high-grade glioma have had inconclusive results.

Lesley Stewart and colleagues from the MRC Clinical Trials Unit, London, UK, did a systematic review and meta-analysis using updated data on individual patients from all available randomised trials that compared radiotherapy alone with radiotherapy combined with chemotherapy. Data on around 3000 patients from 12 randomised controlled trials were included.

Patients given chemotherapy in addition to radiotherapy had a modest (6%) increase in one-year survival compared with patients only given radiotherapy (46% versus 40%, respectively). Patients given chemotherapy also had a two-month increase in average survival time.

Lesley Stewart comments: The clear effect observed in this comprehensive review does show that high-grade gliomas can respond to chemotherapy and that further research into newer chemotherapies and methods of delivery is justified. The size of the benefit and remaining uncertainty about quality of life mean that some health professionals would consider radiotherapy alone to be a justified standard therapy, whereas others might believe that the appropriate standard therapy should now include a nitrosourea [class of chemotherapeutic agent]. Both camps are likely to agree that the small but clear improvement in survival from chemotherapy encourages further study
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Contact: Richard Lane
richard.lane@lancet.com
44-20-7611-4076
Lancet
21-Mar-2002