Evidence map›Paper›PMID 33647972›Full record

Trial reportNeuro-oncology2021

A prospective phase II randomized trial of proton radiotherapy vs intensity-modulated radiotherapy for patients with newly diagnosed glioblastoma.

Paul D Brown, Caroline Chung, Diane D Liu, Sarah McAvoy, David Grosshans, Karine Al Feghali, Anita Mahajan, Jing Li, Susan L McGovern, Mary-Fran McAleer and 10 more

Open access · bronzeAbstract readClinical Trial, Phase IIRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Neuro-oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
63citing papers in PubMed, 5 pooled it
10.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

63 citing papers in PubMed, 5 syntheses or guidelines pooled it, 109 citations in OpenAlex.

  1. Evidence-based indications for proton therapy in adults determined using the GRADE approach.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
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  17. Current state of proton therapy for tumors of the central nervous system in Spain: physical bases, indications, controversies and perspectives.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025
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3 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 6 institutions in 1 country.

Paul D BrownDepartment of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Caroline ChungDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Diane D LiuDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Sarah McAvoyDepartment of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA.
David GrosshansDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Karine Al FeghaliDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Anita MahajanDepartment of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Jing LiDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Susan L McGovernDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Mary-Fran McAleerDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Amol J GhiaDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Erik P SulmanDepartment of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA.
Marta Penas-PradoCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
John F de GrootDepartment of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Amy B HeimbergerDepartment of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jihong WangDepartment of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Terri S ArmstrongCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Mark R GilbertCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Nandita Guha-ThakurtaDepartment of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jeffrey S WefelDepartment of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
The University of Texas MD Anderson Cancer Center · USMayo Clinic · USNational Institutes of Health · USCenter for Cancer Research · USNew York University · USUniversity of Maryland, Baltimore · US

Funding

Brain Tumor Clinical and Clinical Research Program (Clinical Support Services)ZIDBC011642 · NCI · DIVISION OF BASIC SCIENCES - NCI · PI OZER, BYRAM · 2015 to 2025
$23.4M
Outcomes and Risk of Rare TumorsZIABC011837 · NCI · DIVISION OF BASIC SCIENCES - NCI · PI ARMSTRONG, TERRI S. · 2018 to 2024
$2.7M
Dr. Marnie Rose FoundationMD Anderson Cancer Center
6 · The paper itself

Abstract

backgroundTo determine if proton radiotherapy (PT), compared to intensity-modulated radiotherapy (IMRT), delayed time to cognitive failure in patients with newly diagnosed glioblastoma (GBM).

methodsEligible patients were randomized unblinded to PT vs IMRT. The primary endpoint was time to cognitive failure. Secondary endpoints included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported outcomes (PROs).

resultsA total of 90 patients were enrolled and 67 were evaluable with median follow-up of 48.7 months (range 7.1-66.7). There was no significant difference in time to cognitive failure between treatment arms (HR, 0.88; 95% CI, 0.45-1.75; P = .74). PT was associated with a lower rate of fatigue (24% vs 58%, P = .05), but otherwise, there were no significant differences in PROs at 6 months. There was no difference in PFS (HR, 0.74; 95% CI, 0.44-1.23; P = .24) or OS (HR, 0.86; 95% CI, 0.49-1.50; P = .60). However, PT significantly reduced the radiation dose for nearly all structures analyzed. The average number of grade 2 or higher toxicities was significantly higher in patients who received IMRT (mean 1.15, range 0-6) compared to PT (mean 0.35, range 0-3; P = .02).

conclusionsIn this signal-seeking phase II trial, PT was not associated with a delay in time to cognitive failure but did reduce toxicity and patient-reported fatigue. Larger randomized trials are needed to determine the potential of PT such as dose escalation for GBM and cognitive preservation in patients with lower-grade gliomas with a longer survival time.

Indexed as

Brain NeoplasmsGlioblastomaRadiotherapy, Intensity-ModulatedHumansProspective StudiesProtonsProtonscognitionglioblastomaproton therapyradiationrandomized controlled trial

Identifiers

PMID33647972
PMCPMC8328012
OpenAlexW3135657888

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.