| BackgroundGlioblastoma is the most common malignant primary brain tumor in adults.It often recurs and has an extraordinarily poor prognosis.Radiotherapy combined withconcurrent/adjuvant temozolomide chemotherapy is the standard treatment after surgery in glioblastoma.In elderly patients with glioblastoma,hypofractionated radiotherapy has the same therapeutic effect as conventional radiotherapy,and the treatment time is shorter and the cost is lower.However,in all age groups,the efficacy and safety of hypofractionated radiotherapy combined with temozolomide chemotherapy for glioblastoma are still unclear.MethodChapter 1:A comprehensive electronic literature search of PubMed,Web of Science and Cochrane Library was conducted.Using the meta-analysis method,the main assessment data are the overall survival rate of the included population at 12 months and 24 months,and the progression-free survival rate at 6 months and 12 months.The secondary assessment data is the incidence of toxicity.Chapter 2:Search in the electronic medical record system for newly diagnosed glioblastoma patients who received hypofractionated radiotherapy combined with temozolomide chemotherapy in our center was conducted.After basic data collection of the included population,follow-up was conducted to obtain survival data such as overall survival time and progression-free survival time,as well as the incidence of toxicity.ResultChapter 1:Eleven studies met the inclusion criteria,which totally contained 484 participants.The 12-month and 24-month overall survival rate in glioblastoma patients who received hypofractionated radiotherapy combined with temozolomide chemotherapy were 71.3%and 34.8%,while the 6-month and 12-month progression-free survival rate were 74.0%and 40.8%.Compared to low biologically effective dose schedules(<78Gy),high biologically effective dose schedules(=>78Gy)may increase progression-free survival benefit both in 6 months(P=0.003)and 12 months(P=0.011),while the difference did not show on overall survival.Different dose per fraction had no significant effect on both overall survival and progression-free survival.Incidence of radionecrosis was 14.2%.Although the overall incidence of adverse events cannot be quantified,the toxicity of hypofractionated radiotherapy combined with temozolomide chemotherapy was acceptable.Chapter 2:A total of 55 newly diagnosed glioblastoma patients in our center met the inclusion criteria,of which 27 and 28 patients received hypofractionated and conventional radiotherapy,respectively.As of the last follow-up,more than half of the patients in both groups were alive,so it is not yet suitable to assess the overall survival time and further analysis.For the progression-free survival time,the hypofractionated radiotherapy group was 9.6 months(95%CI 6.8-14.6 months),while the conventional radiotherapy group was 10.7 months(95%CI 8.2 months-not reached),there was no statistical difference between the two groups(P=0.35).In the subgroup analysis,the treatment effect of the hypofractionated schedule with the higher total dose seemed to be better than the lower schedule,although no statistical difference was shown(P=0.097).In terms of the incidence of toxicity,hypofractionated radiotherapy did not increase significantly compared with conventional radiotherapy.It can be considered that hypofractionated radiotherapy combined with temozolomide chemotherapy has good safety in patients with glioblastoma.ConclusionCombined with temozolomide chemotherapy,hypofractionated radiotherapy and conventional radiotherapy have similar effects on newly diagnosed glioblastoma of all ages,and a higher biologically effective dose schedule may increase survival benefits.The toxicity of hypofractionated radiotherapy combined with temozolomide chemotherapy is acceptable.It is worthwhile to conduct further clinical randomized controlled trials to evaluate the specific efficacy of hypofractionated radiotherapy combined with temozolomide chemotherapy in glioblastoma. |
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