The impact of short-course hypofractionated radiotherapy on multimodality treatment utilisation, compliance, and outcome in glioblastoma patients: a Danish patterns of care study

Abstract

Background

The aim of this retrospective registry-based Danish patterns of care study was (1) to evaluate the real-world utilisation of short-course hypofractionated radiotherapy (HFRT) in glioblastoma (GBM) patients over time, and (2) to evaluate the impact of short-course HFRT by assessing trends in multimodality treatment utilisation, compliance, and outcome.

Material and methods

Data of all adults with newly diagnosed pathology-confirmed GBM between 2011 and 2019 were extracted from the nationwide Danish Neuro-Oncology Registry. Short-course HFRT was defined as a fraction size of > 2 Gy to a planned dose of > 30 Gy. Patterns of care were assessed. To analyse trends in the assignment to short-course HFRT, and in radiotherapy (RT) compliance, multivariable logistic regression was applied. To analyse trends in survival, multivariable Cox regression was used.

Results

In this cohort of 2416 GBM patients, the utilisation of short-course HFRT significantly increased from ca. 10% in 2011 to 33% in recent years. This coincided with the discontinued use of palliative regimens and a decreased use of conventional fractionation. The proportion of patients proceeding to RT remained stable at ca. 85%. The proportion of patients assigned to chemoradiotherapy (CRT) remained stable at ca. 60%; the use of short-course hypofractionated CRT increased with ca. 10%, while the use of conventionally fractionated CRT decreased with ca. 10%. Compliance with conventionally fractionated and short-course HFRT was respective 92% and 93%, and significantly increasing in recent years. In the complete cohort, the median overall survival remained stable at ca. 11 months. Assignment to short-course HFRT was independently associated with shorter survival.

Conclusion

In Denmark, the use of short-course HFRT significantly increased in recent years. Nonetheless, the overall utilisation of RT and chemotherapy did not increase on a population level. Nor did survival change. In contrast, compliance with both conventionally fractionated RT and short-course HFRT increased.

Keywords:

• Glioblastoma
• conventionally fractionated radiotherapy
• long-course radiotherapy
• hypofractionated radiotherapy
• short-course radiotherapy
• patterns of care
• survival

Acknowledgements

The authors would like to acknowledge the Danish Clinical Quality Program – National Clinical Registries, especially Henriette Engberg, for the contributions regarding the data, and Erik Thorlund Parner, Department of Public Health – Department of Biostatistics, Aarhus University, for the support regarding the statistical analyses.

Ethical approval

This study was deemed exempt by the Central Denmark Region Committees on Health Research Ethics. This study was approved by the Danish Patient Safety Authority (Reg.no. 31-1521-174) and the Danish Clinical Quality Program - National Clinical Registries (Reg.no. DNOR-2020-03-02). The study was registered on the internal registry of research projects of Central Denmark Region (Reg.no. 1-16-02-74-20).

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The used data are freely available by request to the Danish Clinical Quality Program – National Clinical Registries, Danish Neuro-Oncology Registry.

Additional information

Funding

This work was supported by the Danish Comprehensive Cancer Centre Brain Tumour Centre/Danish Cancer Society [Grant no. R295-A16770]; and the Danish Comprehensive Cancer Centre [Grant no. 2021-08].