Abstract
Purpose: To investigate the effect of temozolomide (TMZ) combined with radiotherapy (RT) on O-6- methylguanine-DNA methyltransferase (MGMT) protein and survival of recurrent malignant glioma patients.
 Methods: Ninety-two patients with malignant glioma in our hospital from January 2014 to January 2015 were assigned to study and control groups using the random table method. Subjects in the control group received radiotherapy (total dose in the range of 60 – 75 Gy), while those in the study group were given TMZ orally (75 mg/m2) daily in addition to radiotherapy, as well as TMZ at 150 – 200 mg/m2. After treatment, clinical effectiveness was compared for the two groups. Changes in methylation of MGMT gene were determined in the two groups. The patients were followed up for 3 years, and the degrees of survival and recurrence were recorded.
 Results: Total effectiveness of clinical treatment was markedly higher in the study group (76.09 %) than in the control group (45.65 %; p < 0.05). One month after radiotherapy, significant decrease in MGMT gene methylation was seen in patients in the study group, relative to control patients (p < 0.05). Patients in the study group had lower median recurrence but higher degree of survival in the 2nd and 3rd years, relative to control patients (p < 0.05).
 Conclusion: The combination of temozolomide and radiotherapy is more effective than radiotherapy in the treatment of recurrent malignant glioma. The combined treatment significantly inhibits tumor recurrence in patients, and improves their prognosis and standard of life.
Highlights
Gliomas are tumors derived from neuro-epithelial tissue, and the most common primary intracranial tumors
Inclusion criteria: Patients in the following categories were included: patients with malignant glioma recurrence confirmed by biopsy or postoperative pathology; glioma patients in grade III or grade IV consistent with World Health Organization (WHO) central nervous system tumor grade; glioma patients aged 18 years or above, with estimated survival time ≥ 3 months; patients with Cartesian function score > 60 points; glioma patients who had not received other radiotherapy and chemotherapy within the month preceding the study, and patients who signed informed consent with their family members for the treatment
Other excluded patients included those with severe allergies, especially those who are allergic to TMZ; pregnant and lactating patients, patients who did not follow doctor's advice on the treatment regimen, and those who refused to be followed up
Summary
Gliomas are tumors derived from neuro-epithelial tissue, and the most common primary intracranial tumors. The World Health Organization (WHO) classified gliomas into grades (1 –IV). Grades III and IV are malignant gliomas which account for. 40 – 50 % of all gliomas [1, 2]. It has no obvious boundary with normal brain tissue, and it relapses after surgical resection. It is usually treated with a combination of radiotherapy and chemotherapy. Traditional alkylating agents and chemotherapeutic drugs are the first choices for
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