Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?
The prognosis of patients with glioblastoma (GBM) remains poor,  and the use of hyperfractionation or dose escalation beyond 60 Gy has not  conferred any survival benefit. More recently, hypofractionated radiotherapy (HFRT)  has been employed as a novel approach for achieving dose escalation, with  interesting results. We present here a systematic overview of the role and  development of HFRT as a possible therapeutic strategy in patients with GBM.  We searched the PubMed database for studies published since 1990 that reported  on the tolerance, safety and survival outcomes after HFRT. These studies reported  on the paradox of improved survival in patients developing central radionecrosis  within the high-dose volume. Most series reported no significant increase  in early or late toxicity, except for one study that reported visual loss  in one patient at 7 months after treatment. More recently, studies of HFRT  combined with concurrent temozolomide (TMZ) reported a trend towards  improved survival compared with historical controls, with a few studies reporting  a median survival of approximately 20 months. The interpretation of data from  the above studies is limited by the heterogeneities of patient population  and the significant variation in the range of employed dose schedules. However,  high-dose HFRT using intensity-modulated radiotherapy appears to be a safe  and feasible therapeutic option. There is a suggestion of improved outcomes  on combining HFRT with TMZ, which warrants further investigation in a randomised  trial.
Department of Radiation Oncology, Castle Hill Hospital, Hull, UK. mohan.hingorani@hey.nhs.uk
M
M
Hingorani
W P
WP
Colley
S
S
Dixit
A M
AM
Beavis
D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome