Medical Radiology and Radiation Safety. 2026. Vol. 71. № 5

DOI:10.33266/1024-6177-2026-71-5-139-145

A.S. Druzhinin^{1, 2}, Yu.A. Fedoseenko^{1, 2}, M.O. Skorina¹, I.M. Lebedenko^{1, 2}, M.V. Chernykh¹

ASSESSMENT OF THE QUALITY OF RADIATION TREATMENT PLANNING FOR PATIENTS WITH GLIOBLASTOMA DURING THE TRANSITION TO A HYPO FRACTIONATION REGIME

¹ N.N. Blokhin  National Medical Research Center of Oncology, Moscow, Russia

² National Research Nuclear University MEPhI, Moscow, Russia

Contact person: I.M. Lebedenko, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To evaluate the quality of radiation treatment plans and dose loads on critical structures of patients with glioblastoma during the transition from a standard RT regimen to hypofractionation.

Мaterial and methods: The study included 93 patients with glioblastoma who underwent radiation treatment at the electron accelerator Clinac iX from 2014 to 2022 using intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT). The calculation of irradiation plans was carried out on Eclipse planning systems using dose-volume histograms.

Depending on the fractionation regimen, patients were divided into two groups.  Forty-three patients received treatment using the standard fractionation regimen, and 50 patients received hyperfractionation. In the standard fractionation group, 40 patients received the classical regimen with RD = 2 Gy and 30 fractions, as well as modified regimens: 2 Gy × 26 ( 52 Gy), 2 Gy × 18 ( 36 Gy), and 2 Gy × 17 ( 34 Gy), which is associated with an individualized approach to dosing. A total of 132 courses of radiation therapy were administered, which is explained by the presence of multi-stage treatment in some patients. Dose restrictions for critical structures are based on the data of the international protocols QUANTEC, RTOG, and the recommendations of R. Timmerman

Results: Homogeneity indices (HI) and conformity indices (CI) were calculated. An analysis of dose loads on critical structures revealed that safe doses to the chiasm and optic nerves are achieved using single-stage hyperfractionation approaches. The lowest doses are also observed for the crystalline lens (left and right). Based on the results of the analysis of the homogeneity and conformity indices and the dose loads on critical structures, it can be said that the best fractionation mode is single-stage hypofractionation, which provides an optimal balance between homogeneity, conformity and safety for the critical structures of the visual organs.

Keywords: radiation therapy, glioblastoma, planning quality, hypofractionation

For citation:  Druzhinin AS, Fedoseenko YuA, Skorina MO, Lebedenko IM, Chernykh MV. Assessment of the Quality of Radiation Treatment Planning for Patients with Glioblastoma During the Transition to a Hypo Fractionation Regime. Medical Radiology and Radiation Safety. 2026;71(5):139–145. DOI:10.33266/1024-6177-2026-71-5-139-145

References

1.Koshy M., Villano J.L., Dolecek T.A., Howard A.,Mahmood U., Chmura S.J., Weichselbaum R.R., McCarthy B.J. Improved Survival Time Trends for Glioblastoma Using the SEER 17 Population-Based Registries. J. Neurooncol. 2012;107:207–212.

2.Stupp R., Mason W.P., van den Bent M.J., Weller M., Fisher B., Taphoorn M.J.B., et al. Radiotherapy Plus Concomitant and Adjuvant Temozolomide for Glioblastoma. N. Engl. J. Med. 2005;352;10:987–96. 

3.Peiffer J., Kleihues P. Hans-Joachim Scherer (1906–1945), Pioneer in Glioma Research. Brainpathology .1999;9;2:241–5. Doi:10.1111/j.1750-3639.1999.tb00222.

4.Malmstrom A., Gronberg B.H., Marosi C., Stupp R., Frappaz D., Schultz H., et al. Temozolomide Versus Standard 6-Week Radiotherapy Versus Hypofractionated Radiotherapy in Patients Older than 60 Years with Glioblastoma: the Nordic Randomised, Phase 3 Trial. Lancet Oncol. 2012;13:916–26.

5.Wick W., Platten M., Meisner C., Felsberg J., Tabatabai G., Simon M., et al. Temozolomide Chemotherapy Alone Versus Radiotherapy Alone for Malignant Astrocytoma in the Elderly: the NOA-08 Randomised, Phase 3 Trial. Lancet Oncol. 2012;13:707–15.

6.Roa W., Kepka L., Kumar N., Sinaika V., Matiello J., Lomidze D., et al. International Atomic Energy Agency Randomised Phase III Study of Radiation Therapy in Elderly and/or Frail Patients with Newly Diagnosed Glioblastoma Multiforme. J. Clin. Oncol. 2015;33:4145–50.

7.Sulman E.P., Ismaila N., Armstrong T.S., Tsien C., Batchelor T.T., Cloughesy T., et al. Radiation Therapy for Glioblastoma: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Guideline. J. Clin. Oncol. 2017;35:361–9.

8.Кобяков Г.Л., Абсалямова О.В., Бекяшев А.Х., Голанов А.В., Измайлов Т.Р., Коновалов А.Н. и др. Практические рекомендации по лекарственному лечению первичных опухолей центральной нервной системы // Злокачественные опухоли. 2020. Т.10. №3s2-1. С. 109–133 [Kobyakov G.L., Absalyamova O.V., Bekyashev A.Kh., Golanov A.V., Izmaylov T.R., Konovalov A.N., et al. Practical Recommendations for Drug Treatment of Primary Tumors of the Central Nervous System. Zlokachestvennyye Opukholi = Malignant Tumors. 2020;10;3s2-1:109–133 (In Russ.)]. Doi: 10.18027/2224-5057-2020-10-3s2-07.

9.Lawrence B. Marks, Randall K. Ten Hake Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). International Journal of Radiation Oncology, Biology, Physics. 2010;76;3:S1–S160. 

10.Radiation Therapy Oncology Group (RTOG) Protocols: URL.

11.Timmerman R., Papiez L., McGarry R., et al. Excessive Toxicity when Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer. Journal of Clinical Oncology. 2006;24;30:4833–4839. Doi: 10.1200/JCO.2006.07.5937.

 PDF (RUS) Full-text article (in Russian)

Conflict of interest.The authors declare no conflict of interest.

Financing. The work was carried out with the support of the NRC MEPhI Competitiveness Enhancement Program (Contract No. 02.a03.21.0005).

Contribution. A.S. Druzhinin: selection of clinical material in the planning system, data processing, and drawing; Yu.A. Fedoseenko: idea, selection of clinical material; I.M. Lebedenko: idea, compilation of material, and writing of the article; M.O. Skorina: management of patients, delineation of critical structures, and selection of clinical material; M.V. Chernykh: idea, management of patients, selection of clinical material, and correction of the text

Article received: 20.04.2026. Accepted for publication: 25.05.2026.