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Modified Target Delineation and Moderately Hypofractionated Radiotherapy for High-Grade Glioma: A Randomized Clinical

Liangzhi Zhong1, Pu Zhou2, Lu Chen1

  • 1Cancer Research Institute of the Chinese People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China.

JAMA Network Open
|July 24, 2025
PubMed
Summary
This summary is machine-generated.

This study found that modified target delineation with hypofractionated simultaneous boost intensity-modulated radiotherapy (HSIB-IMRT) in high-grade glioma (HGG) patients resulted in similar survival outcomes but a smaller irradiation volume compared to standard IMRT.

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Area of Science:

  • Radiation Oncology
  • Neuro-oncology
  • Medical Imaging

Background:

  • Optimizing irradiation volumes and dose escalation is crucial for improving outcomes in high-grade glioma (HGG).
  • Accurate target delineation is essential for effective radiotherapy in HGG treatment.

Purpose of the Study:

  • To assess the efficacy of modified target delineation using multimodal MRI and white matter tracts with HSIB-IMRT in newly diagnosed HGG patients.
  • To compare the outcomes of this modified approach against standard IMRT.

Main Methods:

  • A single-center, 2-arm, open-label randomized clinical trial enrolled 154 HGG patients.
  • Patients received either modified target delineation with HSIB-IMRT or standard IMRT, both with concurrent and adjuvant temozolomide chemotherapy.
  • Primary endpoint was progression-free survival (PFS), secondary endpoint was overall survival (OS).

Main Results:

  • Median PFS was 15.5 months (experimental) vs. 13.5 months (standard), P=.89. Median OS was 27.0 months (experimental) vs. 21.0 months (standard), P=.24.
  • The experimental arm had a significantly smaller clinical target volume (P<.001).
  • Recurrence rates and grade 3/4 adverse events were comparable between the arms.

Conclusions:

  • Modified target delineation with HSIB-IMRT achieved comparable PFS and OS to standard IMRT in newly diagnosed HGG.
  • This approach significantly reduced the irradiation target volume without increasing recurrence rates.
  • Results support personalized, reduced-volume strategies to optimize HGG treatment and minimize neurotoxicity.