ID #848 Hypofractionated Radiotherapy as an Alternative to Conventional Fractionation in DIPG: An Updated Meta-analysis Focused on 1-Year OS
Bianca Faria, Pedro Henrique Freitas, Juliana Barreto, Mariana Komatsu, Lilian Cristofani, Beatrice Duarte, Alessandra AzambujaAbstract
Background and Aims
Diffuse intrinsic pontine glioma (DIPG) is a rare, aggressive brainstem tumor, and most patients survive less than one year. Hypofractionated radiotherapy (HFRT) has been proposed as an alternative to conventional fractionated radiotherapy (CRT) because of practical advantages, including fewer hospital visits, lower treatment costs, reduced exposure to sedation, and more time spent at home. Given the rarity of DIPG and the publication of new studies since the last synthesis, an updated meta-analysis is warranted.
Methods
We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing HFRT with CRT in patients with DIPG. The primary outcome was 1-year overall survival (OS). The study was registered in PROSPERO. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a prespecified random-effects model given anticipated heterogeneity. Heterogeneity was assessed with Cochran’s Q and I². Radiotherapy definitions were: CRT, 50–60 Gy in 25–33 fractions; HFRT, 38–45 Gy in 13–16 fractions. Analyses were performed in Review Manager (v5.4.1).
Results
The search identified 1,093 records, of which six met the eligibility criteria, comprising 577 patients (HFRT, n = 294 [50.9%]; CRT, n = 283 [49.1%]) published between 2012 and 2025. HFRT did not significantly differ from CRT for 1-year OS (RR, 1.19; 95% CI, 0.94–1.51; p = 0.16). Observed heterogeneity was low (I² = 0%; p = 0.94).
Conclusions
In this updated meta-analysis of randomized evidence in DIPG, HFRT and CRT yielded comparable 1-year overall survival. Given HFRT’s practical advantages, it may be considered a reasonable alternative to CRT. Additional randomized trials are warranted to confirm these findings and to evaluate quality-of-life and treatment burden outcomes.