Hypofractionated vs. Conventionally fractionated Radiotherapy in the Treatment of Glioblastoma: A Prospective, Randomized Comparative Study

Abstract

Background: Glioblastoma are aggressive primary brain tumors associated with poor prognosis despite multimodality treatment. Hypofractionated radiotherapy (HFRT) has emerged as an alternative to conventionally fractionated radiotherapy (CFRT), particularly in elderly or poor-performance patients. This study compared the efficacy, toxicity, and quality-of-life outcomes of HFRT versus CFRT in patients with poor-prognosis high-grade gliomas.
Materials and Methods: In this prospective randomized study, 21 patients with newly diagnosed high-grade gliomas belonging to RPA class IV–VI were enrolled between November 2017 and June 2019. Patients were randomized to receive either HFRT (40 Gy in 15 fractions over 3 weeks; n=10) or CFRT (60 Gy in 30 fractions over 6 weeks; n=11). All patients received concurrent and adjuvant temozolomide. Primary endpoint was overall survival (OS), while secondary endpoints included progression-free survival (PFS), toxicity, and quality of life (QoL). Treatment response and prognostic factors were analyzed using Cox regression models.
Results: Median PFS was 4.99 months in the HFRT arm and 7.0 months in the CFRT arm (p=0.497). Median OS was 12.5 months with HFRT and 5.8 months with CFRT (p=0.079). No grade 3–4 haematological toxicities were observed in either arm. QoL outcomes were comparable between groups, with fewer significant symptom deteriorations in the HFRT arm. Pre-treatment RPA class was identified as an independent prognostic factor for OS (p=0.014).
Conclusion: HFRT demonstrated comparable survival, acceptable toxicity, and preserved QoL compared with CFRT in glioblastoma patients with poor prognosis, supporting its use as a practical treatment option in selected patients.