The efficacy and safety of radiotherapy with adjuvant temozolomide for glioblastoma: A meta-analysis of randomized controlled studies

The efficacy of radiotherapy with adjuvant temozolomide for glioblastoma remains controversial. We conduct a systematic review and meta-analysis to explore the influence of radiotherapy with adjuvant temozolomide on treatment efficacy for glioblastoma.We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 24, 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of adjuvant temozolomide to radiotherapy for glioblastoma. This meta-analysis is performed using the random-effect model.Five RCTs are included in the meta-analysis. Overall, compared with radiotherapy for glioblastoma, adjuvant temozolomide is associated with substantially improved overall survival (HR = 0.63; 95% CI = 0.52-76; P < 0.00001) and 2-year survival rate (3.25 = 1.76; 95% CI = 2.13-4.94; P < 0.00001), with no increase in adverse events (RR = 0.76; 95% CI = 0.40-1.45; P = 0.41). However, adjuvant temozolomide appears to increase the incidence of haematological complications than only radiotherapy (RR = 3.58; 95% CI = 1.10-11.59; P = 0.03).Adjuvant temozolomide to radiotherapy may provide better efficacy for the treatment of glioblastoma.