Carmustine as a Supplementary Therapeutic Option for Glioblastoma: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Glioblastoma (GBM) is the most aggressive type of primary malignant brain tumor. Carmustine is used by intravenous injection or local implantation in the resection cavity for gliomas, including GBMs. However, the therapeutic potential of carmustine is not well recognized. This analysis aimed to evaluate the survival benefits of carmustine in glioma patients, especially those with GBM. Methods: Randomized controlled trials (RCTs) and cohort studies regarding carmustine for glioma treatment were searched in PubMed, the Cochrane Library, and Embase from January 1979 to March 2020. Quality assessment was conducted with Jadad and Newcastle-Ottawa scales (NOS). Statistical analysis was conducted by Revman 5.3 software. Results: 22 eligible RCTs and cohort studies involving 5821 glioma patients were included. Overall, glioma patients receiving carmustine as adjuvant therapy had better progression-free survival (PFS) (hazard ratio [HR]=0.85, 95% CI=0.77-0.94, P=0.002) and overall survival (OS) (HR=0.85, 95% CI=0.79-0.92, P<0.0001) than those without carmustine treatment. Subgroup analysis showed that the OS benefit was observed in GBM (HR=0.84, 95% CI=0.78-0.91, P<0.00001) but not in anaplastic glioma patients (HR=1.20, 95% CI=0.70-2.07, P=0.50). Additionally, both newly diagnosed and recurrent GBM patients who received carmustine treatment showed better OS (HR=0.86, 95% CI=0.79-0.95, P=0.002; HR=0.77, 95% CI=0.67-0.89, P=0.0002, respectively). Both carmustine implantation in resection cavity and intravenous administration significantly prolonged OS (HR=0.84, 95% CI=0.78-0.92, P<0.0001; HR=0.86, 95% CI=0.75-0.99, P=0.04, respectively). Moreover, GBM patients receiving the combined carmustine and temozolomide (TMZ) therapy had longer OS than those receiving TMZ alone (HR=0.78, 95% CI=0.63-0.97, P=0.03). Conclusion: Carmustine implantation in resection cavity provides survival benefit for GBM patients, and it may be a promising supplement to standard therapeutic protocol by offering a bridge between surgical resection and onset of TMZ therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.029 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".