방사선의학 웹진

바로가기  >

Abstract
Purpose: Radiotherapy (RT) is a cornerstone in GBM management, but the optimal RT regimen for elderly patients remains controversial. To compare survival outcomes of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) in elderly glioblastoma (GBM) patients through a systematic review and meta-analysis.

Methods: A comprehensive search was conducted with Embase, Ovid-Medline, and Cochrane library databases. The hazard ratios (HRs) for overall survival (OS) were pooled using a random-effects model. Subgroup analyses were performed based on treatment modalities, prognostic factors, and age cut-offs.

Results: Nine studies, including 2 prospective randomized trial, comprising 1,441 patients were included. The pooled analysis indicated no statistically significant difference in OS between HFRT and CFRT (HR 0.80; 95% confidence interval [CI]: 0.62-1.04). Subgroup analyses revealed that CFRT demonstrated a survival advantage in patients receiving concurrent chemoradiotherapy with temozolomide (TMZ) (HR 0.68; 95% CI: 0.49-0.93). Regardless of the age cut-off of 65 or 70 years, no significant differences were observed between two regimens.

Conclusions: HFRT and CFRT provide comparable survival outcomes, but CFRT may offer significant survival benefits in specific subgroups, when combined with TMZ or adjusted for prognostic factors. HFRT remains a practical alternative for elderly or frail patients, highlighting the need for individualized RT strategies.

그림1 고령 교모세포종 환자에서 저분할 방사선치료(HFRT)와 표준 분할 방사선치료(CFRT) 간 전체 생존율의 위험비(Hazard ratio) 비교

그림2 주요 교란변수를 보정한 고령 교모세포종 환자에서 저분할 방사선치료(HFRT)와 표준 분할 방사선치료(CFRT) 간 전체 생존율의 위험비(Hazard ratio) 비교

Affiliations

Eunji Kim # 1, Hye In Lee # 2, Tae Hoon Roh 3, Young Zoon Kim 4, Do Hoon Lim 5, Se Jin Cho 6, Kihwan Hwang 7, Chan Woo Wee 8 9
1Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
2Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
4Department of Neurosurgery, Center for Cerebrovascular Disease, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. sejinchorad@gmail.com.
7Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. coolghh@gmail.com.
8Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. wcw0108@hanmail.net.
9Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. wcw0108@hanmail.net.
#Contributed equally.