Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

Abstract

Purpose Shorter hypofractionated radiation therapy (HF-RT) schedules may have radiobiological, patient convenience and healthcare resource advantages over conventionally fractionated radiation therapy (CF-RT) in glioblastoma (GBM). We report outcomes of young, fit GBM patients treated with HF-RT and CF-RT during the COVID-19 pandemic, and a meta-analysis of HF-RT literature in this patient subgroup. Methods Hospital records of patients with IDH-wildtype GBM treated with HF-RT (50 Gy/20 fractions) and CF-RT (60 Gy/30 fractions) between January 2020 and September 2021 were reviewed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Univariable analysis was performed using Cox regression analysis. A systematic search and meta-analysis of studies from January 2000 to January 2022 was performed. Results 41 patients were treated (HF-RT:15, CF-RT:26). For both HF-RT and CF-RT groups, median age was 58 years and 80–90% were ECOG 0–1. There were more methylated tumours in the HF-RT group. All patients received concurrent/adjuvant temozolomide. At 19.2 months median follow-up, median OS was 19.8 months and not-reached for HF-RT and CF-RT (p = 0.5), and median PFS was 7.7 and 5.8 months, respectively (p = 0.8). HF-RT or CF-RT did not influence OS/PFS on univariable analysis. Grade 3 radionecrosis rate was 6.7% and 7.7%, respectively. 15 of 1135 studies screened from a systematic search were eligible for meta-analysis. For studies involving temozolomide, pooled median OS and PFS with HF-RT were 17.5 and 9.9 months (927 and 862 patients). Studies using shortened HF-RT schedules reported 0–2% Grade 3 radionecrosis rates. Conclusion HF-RT may offer equivalent outcomes and reduce treatment burden compared to CF-RT in young, fit GBM patients.

Evaluating the role of HYpofractionated RAdiotherapy schedule in High Grade GlioMA patients less than 60 years of age during the COVID period- A single Institutional Prospective Observational Study (HYRAMA study)

“…In a study by Stupp et. al median PFS was 6.9 months in radiotherapy + TMZ arm and 5 months with radiotherapy alone, with a HR of 0.54, p < 0.001 [4].…”

“…The landmark Stupp trial showed survival bene t of addition of chemotherapy and formed the basis of post-operative standard of care for HGG patients [4]. However, the protracted long course conventional fractionated radiotherapy regimen HGG is quite inconvenient for patients, taking more than 6 weeks to complete.…”

“…With the onset COVID 19 pandemic, lockdowns and travel restrictions was a challenge for patients undergoing radiotherapy with long schedules. Shorter fractionation schedules which offered similar local control rates and survival would be preferred during a pandemic [4]. Several studies have evaluated the Hypofractionated Radiotherapy (HRT) regimen with acceptable outcomes.…”

The Impact of the COVID-19 Pandemic and Lockdown on the Outcome of Glioblastoma

“…19,20 As a result, different centers adopted different approaches to providing cancer surgery. 19,[21][22][23]…”

Hypofractionated radiotherapy of patients with glioblastoma: the first experience in Ukraine and prospects view

“…Цій категорії пацієнтів присвячена опублікована у 2022 р. праця P. Chidle та співавт., в якій порівняли результати гіпофракційного (CВД -50,0 Гр, 20 фракцій) та конвенційного (СВД -60,0 Гр, 30 фракцій) режимів ПТ у пацієнтів з ГБ молодого віку з високим рівнем функціонального стану (young and fit patients). Установлено, що гПТ може забезпечити еквівалентні результати лікування та зменшити навантаження від лікувального процесу порівняно зі стандартною ПТ у молодих пацієнтів з ГБ з високим функціональним статусом [22].…”