ABSTRACT
In solid adult tumours, owing to its limited clinical efficacy, chemotherapy is seldom used as a sole curative treatment modality. It is however more and more used in combination with curative treatments such as surgery and radiotherapy, at least for locally advanced diseases. Chemotherapy can be delivered before a local treatment in an induction or neo-adjuvant setting, it can be delivered during a local treatment (i.e. during the course of radiotherapy) in a concomitant setting, and it can be delivered after a local treatment in an adjuvant setting. In brain high-grade glioblastoma, Cochrane Reviews recently published a report on all the randomised controlled trials performed on the use of temozolomide and radiotherapy. In summary, in primary glioblastoma, temozolomide significantly increased overall survival (hazard ratio 0.60, p-value 0.0003) and progression-free survival (hazard ratio 0.63, p-value 0.02) without modification of the quality of life; the benefit was mainly observed when temozolomide was given both concomitantly and in an adjuvant setting. The risks of haematological complications, fatigue and infections were increased with temozolomide.
