Hypofractionated vs. conventional fractionated radiotherapy in the temozolomide era for elderly patients with glioblastoma: a systematic review and meta-analysis by the Korean society for neuro-oncology

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.