RADT-35. COMPARISON OF HYPOFRACTIONATED ACCELERATED RADIOTHERAPY (HART) WITH CONVENTIONAL FRACTIONATED RADIOTHERAPY (CFRT) IN NEWLY DIAGNOSED HIGH GRADE GLIOMA (HGG): A RANDOMISED TRIAL

Abstract BACKGROUND For all high-grade gliomas (HGG), the standard management includes surgery followed by chemoradiotherapy and adjuvant chemotherapy. Despite this prognosis remain poor with a median overall survival (OS) of 14.6 months. Hypofractionation radiotherapy (HART) offers potential advantages like dose escalation and short treatment time, though current evidence is limited. This randomized study aims to compared HART with conventional fractionated radiotherapy (CFRT) as non-inferiority in survival outcomes. METHODS Patients with age ≥ 18 years with KPS ≥70 were randomized post-surgery to either CFRT or HART. CFRT consisted of 60Gy in 30 fractions (5 fractions per week over 6 weeks), while HART delivered 60Gy in 20 fractions (5 fractions per week over 4 weeks). Both arms received standard Temozolomide. Quality of life (QOL) was assessed using the EORTC QLQ-C30 and QLQ-BN20 questionnaires. RESULTS From January 2023 to May 2025, a total of 97 patients (49 in CFRT, 48 in HART arm) were completed treatment and were followed up. The median age was 46 years (range: 20-73). A total of 36 patients died (20 in CFRT, 16 in HART). Mean OS was 18.28 months overall, with 16.21and 18.95 months in the CFRT and HART arms, respectively (HR= 0.71, 95% confidence interval (CI), 0.35 to 1.43, p= 0.34) and median progression free survival (PFS) was 10 months overall, with 12 and 10 months in the CFRT and HART arms, respectively (HR=0.75, 95% CI 0.42 to 1.32, p= 0.32). HART demonstrated comparable efficacy to CFRT with the added benefit of shorter treatment duration and similar QOL outcomes. CONCLUSION HART showed non-inferior outcomes compared to CFRT, with no increase in toxicity. Its advantages include a higher biologically effective dose (BED) and reduced treatment time. Larger studies are warranted to validate HART as a standard treatment approach for HGG.