Comparison of the Effectiveness of Radiotherapy with 3D-CRT, IMRT, VMAT and PT for Newly Diagnosed Glioblastoma: A Bayesian Network Meta-Analysis

Simple Summary This study investigated the effectiveness of different modern radiotherapy strategies in the treatment of patients with newly diagnosed glioblastoma using a comprehensive review of the literature from sources such as MEDLINE, Embase and the Cochrane Central Registry. It included randomized and nonrandomized trials on treatments such as three-dimensional conformal radiotherapy, intensity-modulated radiotherapy and proton therapy, assessing their impact on overall survival and progression-free survival. A Bayesian network meta-analysis was utilized to provide a nuanced comparison of the varied therapies. The analysis of 816 patients from six studies indicated the significant benefit of proton therapy in terms of the survival outcomes, suggesting that proton therapy might be most effective for primary glioblastoma.Abstract Background: This study aimed to assess the relative efficacy of modern radiotherapy strategies in patients with newly diagnosed glioblastoma. Method: A comprehensive literature review was conducted through MEDLINE, Embase and the Cochrane Central Registry of Controlled Trials of studies focused on newly diagnosed glioblastoma published up to and counting 15 September 2022. We included randomized controlled trials (RCTs) and comparative nonrandomized studies (NRSs) of radiotherapy for newly diagnosed glioblastoma. Eligible studies included patients treated with three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, volumetric modulated arc therapy or proton therapy reporting either overall survival, progression-free survival or both. The impact of different radiotherapy modalities on survival was evaluated by direct comparisons of indirect evidence and estimated hazard ratios in terms of a Bayesian network meta-analysis. Results: A total of six RCTs or NRSs comprising 816 glioblastoma patients with modern radiotherapy strategies were reviewed, yielding improved overall survival by proton therapy over all other regimens. The network meta-analysis also indicated a significant advantage of proton therapy compared with other radiotherapy strategies in regard to progression-free survival. Conclusion: Our findings suggested PT as a standard RT regime with possibly superior survival outcomes for selected patients with GBM.