Cochrane · systematic review · CD013261
Treatment of newly diagnosed glioblastoma in the elderly: a network meta‐analysis
Hanna, C, Lawrie, TA, Rogozińska, E, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Gynaecological, Neuro-oncology and Orphan CancerAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
45
current version
GRADE rated
23
No studies
4
Included studies
NR
No studies 4 · 8.9%Ungraded 18 · 40%Very low 2 · 4.4%Low 11 · 24.4%Moderate 8 · 17.8%High 2 · 4.4%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings on overall survival comparing treatments to supportive care only
Population: elderly people with newly diagnosed glioblastoma Interventions: radiotherapy with 40 Gy in 15 fractions (RT40); radiotherapy with 60 Gy in 30 fractions (RT60); chemoradiotherapy (CRT); chemoradiotherapy plus bevacizumab (BEV_CRT); radiotherapy plus bevacizumab (BEV_RT); temozolomide (TMZ) Comparison: supportive care only Outcome: overall survival
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Supportive care only*** (1 RCT, 81 participants) | no estimate extracted | 1 study · 81 participants | Ungraded |
RT60 (5 RCTs; 713 participants) | HR 0.47 [0.29, 0.76] | 5 studies · 60 participants | Moderate |
BEV_RT (1 RCT; 75 participants) | HR 0.48 [0.23, 1] | 1 study · 75 participants | Ungraded |
RT40 (4 RCTs; 930 participants) | HR 0.44 [0.25, 0.77] | 4 studies · 40 participants | Low |
TMZ (3 RCTs, 538 participants) | HR 0.42 [0.25, 0.71] | 3 studies · 538 participants | Low |
CRT (2 RCTs; 635 participants) | HR 0.3 [0.17, 0.53] | 2 studies · 635 participants | Ungraded |
BEV_CRT (1 RCT; 73 participants) | HR 0.25 [0.11, 0.54] | 1 study · 73 participants | Ungraded |
Summary of findings on overall survival comparing treatments to hypofractionated radiotherapy
Population: elderly people with newly diagnosed glioblastoma Interventions: chemoradiotherapy (CRT); chemoradiotherapy plus bevacizumab (BEV_CRT); radiotherapy plus bevacizumab (BEV_RT); temozolomide (TMZ) Comparison: hypofractionated radiotherapy (RT 40) Outcome: overall survival
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
RT 40 (4 RCTs; 930 participants) | no estimate extracted | 4 studies · 40 participants | Ungraded |
BEV_RT (1 RCT; 75 participants) | HR 1.08 [0.66, 1.78] | 1 study · 75 participants | Low Downgraded: imprecision |
TMZ (3 RCTs, 538 participants) | HR 0.95 [0.71, 1.26] | 3 studies · 538 participants | Low Downgraded: imprecision |
CRT (2 RCTs; 635 participants) | HR 0.67 [0.56, 0.8] | 2 studies · 635 participants | High |
BEV_CRT (1 RCT; 73 participants) | HR 0.56 [0.31, 0.99] | 1 study · 73 participants | Moderate Downgraded: imprecision |
Summary of findings on overall survival comparing treatments to standard radiotherapy
Population: elderly people with newly diagnosed glioblastoma Interventions: radiotherapy with 40 Gy in 15 fractions (RT 40); chemoradiotherapy (CRT); chemoradiotherapy plus bevacizumab (BEV_CRT); radiotherapy plus bevacizumab (BEV_RT); temozolomide (TMZ); Comparison: standard radiotherapy (RT 60) Outcome: overall survival
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
RT 60 (5 RCTs; 713 participants) | no estimate extracted | 5 studies · 60 participants | Ungraded |
RT 40 (4 RCTs; 930 participants) | HR 0.94 [0.72, 1.23] | 4 studies · 40 participants | Low Downgraded: imprecision |
BEV_RT (1 RCT; 75 participants) | HR 1.01 [0.58, 1.79] | 1 study · 75 participants | Very low Downgraded: imprecision |
TMZ (3 RCTs, 538 participants) | HR 0.89 [0.71, 1.11] | 3 studies · 538 participants | Very low Downgraded: imprecision, inconsistency |
CRT (2 RCTs; 635 participants) | HR 0.63 [0.46, 0.87] | 2 studies · 635 participants | Low Downgraded: imprecision, inconsistency |
BEV_CRT (1 RCT; 73 participants) | HR 0.52 [0.28, 0.98] | 1 study · 73 participants | Ungraded |
Summary of findings on quality of life
Population: elderly people with newly diagnosed glioblastoma Interventions: one treatment option Comparison: an alternative treatment option
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
RT vs supportive care only | no estimate extracted | 1 study · 59 participants | Low Downgraded: imprecision |
Hypofractionated RT vs standard RT (60Gy/30 fractions) | no estimate extracted | 2 studies · 85 participants | Low Downgraded: imprecision |
TMZ vs RT | no estimate extracted | 1 study · 306 participants | Moderate Downgraded: risk of bias, imprecision |
CRT vs RT | no estimate extracted | 1 study · 562 participants | Ungraded |
BEV_CRT vs CRT | no estimate extracted | 1 study · 73 participants | Ungraded |
BEV_RT vs RT | no estimate extracted | 1 study · 75 participants | Ungraded |
RIN_CRT vs control/CRT | no estimate extracted | 1 study · 174 participants | Ungraded |
TTF_AC vs CRT | no estimate extracted | 1 study · 134 participants | Ungraded |
IRI_BEV_RT vs CRT | no estimate extracted | 1 study · 34 participants | Ungraded |
Summary of findings on progression‐free survival
Population: elderly people with newly diagnosed glioblastoma Interventions: one treatment option Comparison: an alternative treatment option
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
RT vs supportive care only | HR 0.28 [0.17, 0.46] | 1 study · 81 participants | Moderate Downgraded: imprecision |
Hypofractionated RT vs standard RT (60Gy/30 fractions) | no estimate extracted | 1 study · 64 participants | Ungraded |
TMZ vs RT | HR 1.15 [0.92, 1.44] | 1 study · 373 participants | Low Downgraded: risk of bias, imprecision |
CRT vs RT | HR 0.5 [0.41, 0.61] | 1 study · 562 participants | High |
BEV_CRT vs CRT | HR 0.78 [0.46, 1.32] | 1 study · 73 participants | Low Downgraded: imprecision |
BEV_RT vs RT | HR 0.46 [0.27, 0.78] | 1 study · 75 participants | Moderate Downgraded: imprecision |
RIN_CRT vs CRT | no estimate extracted | NR | No studies |
TTF_AC vs CRT | no estimate extracted | NR | No studies |
IRI_BEV_RT vs CRT | no estimate extracted | NR | No studies |
Summary of findings on severe adverse events
Population: elderly people with newly diagnosed glioblastoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
RT vs supportive care only | no estimate extracted | NR | No studies |
Hypofractionated RT vs standard RT (60Gy/30 fractions) | no estimate extracted | 1 study · 61 participants | Ungraded |
TMZ vs RT | no estimate extracted | 1 study · 373 participants | Moderate Downgraded: imprecision |
CRT vs RT | no estimate extracted | 1 study · 562 participants | Moderate Downgraded: imprecision |
BEV_CRT vs CRT | no estimate extracted | 1 study · 73 participants | Moderate Downgraded: imprecision |
BEV_RT vs RT | no estimate extracted | 1 study · 75 participants | Low Downgraded: imprecision |
RIN_CRT vs CRT | no estimate extracted | 1 study · 174 participants | Ungraded |
TTF_AC vs AC | no estimate extracted | 1 study · 134 participants | Ungraded |
IRI_BEV_RT vs CRT | no estimate extracted | 1 study · 34 participants | Ungraded |