Efficacy and Safety of Hypofractionated Stereotactic Radiotherapy for Recurrent Malignant Gliomas: A Systematic Review and Meta-analysis

The current treatment for patients with relapsed malignant glioma (MG) remains unsatisfactory. Use of hypofractionated stereotactic radiotherapy (HFSRT) for recurrent MG has shown some encouraging results and may be a viable option. We performed a systematic review and meta-analysis of articles that investigated the use of HFSRT for recurrent MG. Relevant studies were obtained through searching PubMed, Embase, and the Cochrane Library. Data about treatment regimens, median overall survival, and radiation necrosis (RN), as well as other major neurologic complications were extracted. We performed a descriptive analysis of the median overall survival and meta-analysis of the reported rates of RN and other major neurologic complications (MNCs). A total of 26 studies were included in our study, comprising 861 patients. Median overall survival ranged from 8.6 to 18 months. A total of 19 studies were included to perform a meta-analysis of the RN rate and the pooled RN rate was 5% (3%–7%). The pooled rate of other MNCs was 2% (1%–4%), calculated from 20 studies. The present evidence suggests that HFSRT is an efficacious and safe treatment approach to treat patients with recurrent MG. However, the retrospective and observational nature of the studies included in our systematic review and meta-analysis restricted formation of more solid conclusions. Thus, well-designed prospective controlled trials are warranted to further define the therapeutic role of HFSRT for recurrent MG.