System review and meta-analysis of low-level glioma therapy

Study backgroundlow-level gliomas, WHO Grade I and II stage semenglioomas accounted for 17%-22% of primary intracranial tumors, andtheir survival depended on pathological type and molecular characteristics, with a median of 5.6-13.3 yearstreatment forlow-level gliomas includesurgical excision, radiotherapy and chemotherapy;but there has been debate about the treatment modelTimothy JBrown of the University of Texas Southwestern Medical Center in Dallas, USA, and others systematically reviewed the extent of surgical resection of low-level gliomas, the relationship between radiotherapy and chemotherapy and mortality, and disease progressionresults are available online in August 2018research methods
authors retrieve relevant literature registered on pubmed by September 201747 articles included in the retrospective analysis, of which 29 were surgically treated, 13 were radiotherapy and 5 were chemotherapyresearchers took data on patientage, tumor size, and IDH1 R132H mutation status from the literatureand analyzed the high-quality evidence of Class I and Class II respectively, and the low-quality evidence subset of Class III and Class IVevaluate synods in the following three areas of the tumor:1 Comparison Total Excision (GTR) and Secondary Total Excision (STR), Chemotherapy and Unchemotherapy, Early Radiotherapy and Prognosis without Radiotherapy or Delayed Radiotherapy, the main result is the relative risk of death and disease progression at 2, 5 and 10 years after surgery2 relative risk of effecton of efficacy to effects of lower dose (45-55Gy) radiotherapy and high dose (59-65Gy), sub-total excision and biopsy, arbitrary degree of excision and biopsy, and the correlation between chemotherapy and the mutation status of IDH1 R132H3 uses all the data obtained from selected research text or images for prognosis analysisresultsresults show that the relative risk of death in 2, 5 and 10 years after surgery was found to be relatively riskrr and 95%CI at 2, 5 and 10 years after surgery, compared with 3,891 cases of low-level gliomas and s.RR9.39;95% CI, 0.29-0.51 (P.0.001);NNT s 6) and .RR?0.50;95% CI, 0.35-0.70 (P.0.001);NNT-4RR and 95% CI for disease progression of 2, 5 and 10 years aftertumor GTR and STR surgery, respectively, were RR-0.37;95% CI, 0.24-0.57 (P.0.001);NNT?7,RR-0.50;95% CI, 0.39-0.64 (P 0.001);NNT?compared 1918 cases of low-level glioma postoperative radiotherapy with delayed radiotherapy or unradiolated pre-treatment, and found that the death RR and 95% CI were rr-0.92, respectively, in 2, 5 and 10 years after surgery 95% CI, 0.53-1.58; P.0.76, RR?0.93; 95% CI, 0.60-1.43; P-0.73) and "RR-0.99; 95% CI, 0.69-1.41; P-0.95) RR and 95% CI of disease progression in 2, 5 and 10 years after surgery were RR and 95% CI, respectively, with RR-0.66; 0.51-0.86 (P-0.002); NNT?10), RR-0.73, 95% CI, 0.61-0.88 (P.0.001 ); NNT?6 and .RR-0.74; 95% CI, 0.60-0.91 (P-0.005) 2 higher-dose radiotherapy and low-dose radiotherapy studies show that RR and 95% CI died in 2 years and 5 years after surgery, respectively, are RR?1.63; 95% CI, 0.81-3.31; P-0.17 and .2.09; 95% CI, 0.88-1.35; P-0.45, respectively 2 and 5 years of disease progression RR and 95% CI are the "RR s 1.46; 95% CI, 1.06-2.01; P s.02 and .RR s.00; 95% CI, 0.84-1.18; P s 0.97) compared 567 cases of low-level glioma after radiotherapy and pre-chemotherapy after radiotherapy, and after the pre-treatment of non-chemotherapy, the death RR 2, 5 and 10 years after surgery and 95% CI were .RR-1.34, respectively; 95% CI, 0.85-2.12; P s 0.21, RR?0.83; 95% CI, 0.64-1.09; P-0.18) and "RR-0.77; 95% CI, 0.58-1.03, P-0.08) RR and 95% CI for disease progression 2, 5 and 10 years, respectively, are RR-0.92; 95% CI, 0.64-1.33; P-0.86, RR-0.69; 95% CI, 0.55-0.87 (P-0.001 ); NNT?6 and "RR-0.58; 95% CI, 0.39-0.87 (P-0.00N); 2 studies provided data on low-level gliomas of the IDH1 R132H mutation, compared to the control group of idh1 R132H mutant patients with chemotherapy, RR and 95% CI of disease progression in 2, 5 and 10 years after surgery, respectively, with the progression of the disease 95% CI, 0.06-4.1; P.0.5,, RR?0.27; 95% CI, 0.08-0.84 (P-0.02); NNT s.3, and RR.21; 95% CI, 0.03-1.59; P.13 analyze the prognosis factors of low-grade gliomas, taking into account all valid data tumors are greater than 5cm (HR s 2.0; 95% CI, 1.53-2.61; 0.001), tumors located in the functional area of the brain (HR?1.98; 95% CI, 1.20-3.26; P-0.008, IDH1 R132H wild-type tumors , HR, 2.38, 95% CI, 1.16-5.00; p-0.02) and preoperative KPS-80% .HR-3.66; 95% CI, 0.82-16.3; P-0.088) in studies that provided evidence in Class I or Class II, the maximum diameter of the tumor was greater than 5cm 95% CI, 1.48-3.50; P 0.001), tumors located in the functional area of the brain,
95% CI, 1.82-48.3; P-0.007, IDH1 R132H wild -type tumors P-0.02, postoperative KPS,"/80% of THE 95% CI, 1.10-5.55; P-0.28) and preoperative KPS of 80% (HR?7.35; 95% CI, 2.96-18.2; P.0.001) are at greater risk of death in two analyses, age of 40 was not a significant predict or of short-lived periods conclusions authors note that removal within the maximum safe range of low-level gliomas can improve overall patient survival and progression-free survival for 2, 5 and 10 years after surgery but a forward-looking randomized controlled clinical trial is still needed early postoperative radiotherapy had no obvious effect on survival, but it could improve the non-progressive survival the role of chemotherapy remains uncertain two studies included 182 cases of idh1 R132H mutant low-level glioma patients receiving radiotherapy and chemotherapy, and the non-progressive survival improved over 5 years the maximum diameter of the tumor is 5cm, the lesions are located in the functional area, there is no IDH1 R132H mutation, preoperative or postoperative KPS of 80% of the patients have a high risk of death age of 40 is not a predictor of survival.