Adjuvant Thermotherapy Using Magnetic Nanoparticles in High-grade Glioma: A Systematic Review and Meta-analysis
Mariano Belfort Santos1, Carolina Moura2, Kenzo Ogasawara3, Marianna Leite4, Vida Castella5, Pedro Cedraz1, Kizzes Paiva1, Thaila Pereira Schmidt6, Cleydson Santos1
1Zarns School of Medicine, 2Hospital Universitário Antonio Pedro, 3Bahiana School of Medicine and Public Health, 4School of Medicine, Santa Marcelina College, 5Medical School of Petropolis, 6Americas Servicos Medicos
Objective:
This systematic review and meta-analysis aim to evaluate the impact of intratumoral thermotherapy on overall survival (OS), progression-free survival (PFS), complications, mortality, and MGMT methylation profile in high-grade gliomas (HGG).
Background:
High-grade gliomas (HGG) are aggressive brain tumors with poor prognosis, despite multimodal treatment approaches. Intratumoral thermotherapy, using magnetic nanoparticles, has emerged as a potential adjuvant treatment option to treat high-grade gliomas (HGG) due to its ability to use localized electromagnetic induced heat for tumor control.
Design/Methods:
We conducted a comprehensive search of PubMed, EMBASE, and Cochrane databases to identify studies published between 2000 and 2023 evaluating the effects of thermotherapy with magnetic nanoparticles in HGG. Eligible studies included clinical study, case-report series, and retrospective analyses. Data were extracted and pooled using random-effects models to calculate hazard ratios (HR) and 95% confidence intervals (CI).
Results:
Four studies, involving 97 HGG patients, met the inclusion criteria. MGMT methylation was reported in 25% of cases. Intratumoral thermotherapy was associated with an OS from diagnosis of 15 months (95% CI: 11.56–20.38, P=0.69), OS from first recurrence of 17.2 months (95% CI: 9.53–25.00, P=0.12), and PFS after at least one recurrence of 10 months (95% CI: 5.88–14.31, P=0.30). Also, complications occurred in 64% of patients, with edema being the most prevalent (45%). A meta-regression analysis between maximum temperature and edema rates was not statistically significant, with a coefficient of 6.12 (95% CI: -4.95 to 17.19, p = 0.39), likely due to small sample sizes. Finally, mortality events were reported in 85% of patients.
Conclusions:
Intratumoral thermotherapy, in combination with surgery, chemotherapy, and radiotherapy, shows promise in improving OS and PFS in recurrent high-grade gliomas (HGG). While local complications, such as edema, were observed, they were largely reversible. However, the heterogeneity of treatment protocols and small sample sizes limit the generalizability of these finding.
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