Summary of findings 2. Hypofractionated radiotherapy versus daily conventionally fractionated radiotherapy for high grade glioma.
| Hypofractionated radiotherapy vs daily conventionally fractionated radiotherapy for high grade glioma | ||||||
| Patient or population: people with high grade glioma Settings: Intervention: hypofractionated radiation vs conventional radiation | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Conventional radiation | Hypofractionated radiation | |||||
| Overall survival | Study population | HR 0.95 (0.78 to 1.17) | 943 (5 studies) | ⊕⊝⊝⊝ Very lowa,b | — | |
| 1000 per 1000 | 1000 per 1000 (1000 to 1000) | |||||
| High risk population | ||||||
| 1000 per 1000 | 1000 per 1000 (1000 to 1000) | |||||
| Adverse effects | Could not be pooled | Could not be pooled | Not estimable | 848 (4 studies) | — | — |
| Progression free survival | Not reported | Not reported | Not estimable | 0 (0) | — | — |
| Quality of life | Could not be pooled | Could not be pooled | Not estimable | 361 (3 studies) | — | — |
| Overall survival for subgroup aged ≥ 60 years glioblastoma | Study population | HR 1.16 (0.92 to 1.46) | 293 (2 studies) | ⊕⊕⊕⊕ High | — | |
| 1000 per 1000 | 1000 per 1000 (1000 to 1000) | |||||
| High risk population | ||||||
| 1000 per 1000 | 1000 per 1000 (1000 to 1000) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio. | ||||||
| GRADE Working Group grades of evidence High‐certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate‐certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low‐certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low‐certainty: we are very uncertain about the estimate. | ||||||
aAttrition was incompletely described in all the trials except for Roa 2004 and Malmstrom 2012. Phillips 2003 had high risk of bias as the study was closed early due to poor accrual. The publication only included 68 participants. The authors did not comment on the planned sample size. Downgraded two levels for very serious risk of bias. bOnly two trials examined people with glioblastoma aged ≥ 60 years (Malmstrom 2012; Roa 2004). The other older trials did not separate the results for grades 3 and 4 glioma neither was molecular subtype analysis available for the older outdated trials. Downgraded one level (serious) for indirectness.