Department of radiation oncology, Nanfang hospital, Southern medical university, 1838, North Guangzhou avenue, 510515 Guangzhou, China.
Department of radiation oncology, Nanfang hospital, Southern medical university, 1838, North Guangzhou avenue, 510515 Guangzhou, China.
Cancer Radiother. 2021 Apr;25(2):182-190. doi: 10.1016/j.canrad.2020.08.049. Epub 2021 Jan 9.
The efficacy of hypofractionated radiotherapy (HFRT) in glioblastoma (GBM) without age restrictions remains unclear. The aim of this meta-analysis is to access the survival outcomes of HFRT in these patients.
A comprehensive electronic literature search of PubMed, Web of Science and Cochrane Library was conducted up to June 1, 2020. The main evaluation data were the overall survival (OS) rate at 12 months and 24 months and the progression-free survival (PFS) rate at 6 and 12 months. The secondary evaluation data was the incidence of radionecrosis and adverse events. The study was performed using R "meta" package.
Eleven studies met the inclusion criteria, which totally contained 484 participants. The 12-month OS and 24-month OS rate of HFRT in GBM were 71.3% and 34.8%, while the 6-month PFS and 12-month rate were 74.0% and 40.8%. Compared to low-BED (biological equivalent dose) schedules (<78Gy), high-BED schedules may increase survival benefit both in PFS-6 (P=0.003) and PFS-12 (P=0.011), while the difference did not show on OS. Different dose per fraction had no significant effect on both OS and PFS. Incidence of radionecrosis was 14.2%. Although the overall incidence of adverse reactions cannot be quantified, the toxicity of HFRT was acceptable.
Compared with survival data for standard treatment, HFRT seemed to improve overall survival and progression-free survival, while high BED schedules may future increase benefit on PFS. Meanwhile, the toxicity of HFRT was tolerable. Further randomised controlled clinical studies are needed to confirm these findings.
年龄不受限制的低分割放疗（HFRT）在胶质母细胞瘤（GBM）中的疗效尚不清楚。本荟萃分析旨在评估 HFRT 在这些患者中的生存结果。
对 PubMed、Web of Science 和 Cochrane Library 进行了全面的电子文献检索，检索时间截至 2020 年 6 月 1 日。主要评价数据为 12 个月和 24 个月的总生存率（OS）和 6 个月和 12 个月的无进展生存率（PFS）。次要评价数据为放射性坏死发生率和不良事件发生率。研究采用 R“meta”包进行。
符合纳入标准的 11 项研究共包含 484 名参与者。HFRT 治疗 GBM 的 12 个月 OS 率和 24 个月 OS 率分别为 71.3%和 34.8%，6 个月 PFS 率和 12 个月 PFS 率分别为 74.0%和 40.8%。与低生物等效剂量（BED）方案（<78Gy）相比，高 BED 方案在 6 个月 PFS（P=0.003）和 12 个月 PFS（P=0.011）中均能提高生存获益，而在 OS 中则无显著差异。不同的单次剂量对 OS 和 PFS 均无显著影响。放射性坏死的发生率为 14.2%。尽管无法量化不良反应的总体发生率，但 HFRT 的毒性是可以接受的。
与标准治疗的生存数据相比，HFRT 似乎能提高总体生存率和无进展生存率，而高 BED 方案可能会进一步提高 PFS 的获益。同时，HFRT 的毒性是可以耐受的。需要进一步的随机对照临床试验来证实这些发现。
