https://doi.org/10.4081/gc.2025.14114
Glioblastoma cancer: comparing the effectiveness of 3D conformal radiation therapy and volumetric modulated radiotherapy - an artificial intelligence-based survival prediction
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 14 October 2025
This study aimed to evaluate the survival efficacy of different radiotherapy strategies in patients with glioblastoma (GBM). Furthermore, by utilizing various artificial intelligence algorithms and machine learning models, including neural networks, logistic regression, and decision trees, among others, the possibility of obtaining outcome predictions for a specific point in time was explored. The study considered data from radiotherapy treatments for patients affected by GBM. Eligible data included patients treated with 3D conformal radiotherapy or intensity-modulated radiotherapy, who reported overall survival and progression-free survival. The impact of different radiotherapy modalities on survival was evaluated through direct comparisons of the available data. In the second part of the study, the possibility of using artificial intelligence to predict the survival status of patients after a specific period following the end of radiation treatment was explored. To test our hypothesis, we used data from new patients and asked the machine learning models with the best fit to our data to predict survival for these new patients. A total of 30 elderly GBM patients treated with modern radiotherapy strategies were examined, showing a better overall survival when volumetric modulated radiotherapy (VMAT) was used compared to the 3D conformal radiation therapy technique. The artificial intelligence algorithm was asked to predict the survival status of three new patients. The neural network method, compared to the others used, is the one that responded correctly in 100% of the cases submitted. In second place was the decision tree method, which responded correctly in 67% of the cases. Our results suggested VMAT as a standard radiotherapy modality with potentially superior survival outcomes for selected patients with GBM.
Downloads
Brodbelt A, Greenberg D, Winters T, et al. Glioblastoma in England: 2007-2011. Eur J Cancer 2015;51:533-42. DOI: https://doi.org/10.1016/j.ejca.2014.12.014
Larjavaara S, Mäntylä R, Salminen T, et al. Incidence of gliomas by anatomic location. Neuro Oncol 2007;9:319-25. DOI: https://doi.org/10.1215/15228517-2007-016
Gállego Pérez-Larraya J, Hildebrand J. Brain metastases. Handb Clin Neurol 2014;121:1143-57. DOI: https://doi.org/10.1016/B978-0-7020-4088-7.00077-8
Lapointe S, Perry A, Butowski NA. Primary brain tumours in adults. Lancet 2018;392:432-46. DOI: https://doi.org/10.1016/S0140-6736(18)30990-5
Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016;131:803-20. DOI: https://doi.org/10.1007/s00401-016-1545-1
Aldape K, Zadeh G, Mansouri S, et al. Glioblastoma: pathology, molecular mechanisms and markers. Acta Neuropathol 2015;129:829-48. DOI: https://doi.org/10.1007/s00401-015-1432-1
Li G, Citrin D, Camphausen K, et al. Advances in 4D medical imaging and 4D radiation therapy. Technol Cancer Res Treat 2008;7:67-81. DOI: https://doi.org/10.1177/153303460800700109
Van De Bunt L, Van Der Heide UA, Ketelaars M, et al. Conventional, conformal, and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer: the impact of tumor regression. Int J Radiat Oncol Biol Phys 2006;64:189-96. DOI: https://doi.org/10.1016/j.ijrobp.2005.04.025
Hamer P, Tremblay J. Artificial intelligence in medicine. Metabolism 2017;69:S36-40. DOI: https://doi.org/10.1016/j.metabol.2017.01.011
Hosny A, Parmar C, Quackenbush J, et al. Artificial intelligence in radiology. Nat Rev Cancer 2018;18:500-10. DOI: https://doi.org/10.1038/s41568-018-0016-5
Mintz Y, Brodie R. Introduction to artificial intelligence in medicine. Minim Invasive Ther Allied Technol 2019;28:73-81. DOI: https://doi.org/10.1080/13645706.2019.1575882
Johnson KW, Torres Soto J, Glicksberg BS, et al. Artificial intelligence in cardiology. J Am Coll Cardiol 2018;71:2668-679. DOI: https://doi.org/10.1016/j.jacc.2018.03.521
Senders JT, Staples PC, et al. Machine learning and neurosurgical outcome prediction: a systematic review. World Neurosurg 2018;109:476-86. DOI: https://doi.org/10.1016/j.wneu.2017.09.149
Christodoulou E, Ma J, Collins GS, et al. A systematic review shows no performance benefit of machine learning over logistic regression for clinical prediction models. J Clin Epidemiol 2019;110:12-22. DOI: https://doi.org/10.1016/j.jclinepi.2019.02.004
Austin PC, Tu JV, Ho JE, et al. Using methods from the data-mining and machine-learning literature for disease classification and prediction: a case study examining classification of heart failure subtypes. J Clin Epidemiol 2013;66:398-407. DOI: https://doi.org/10.1016/j.jclinepi.2012.11.008
El-Solh AA, Hsiao CB, Goodnough S, et al. Predicting active pulmonary tuberculosis using an artificial neural network. Chest 1999;116:968-73. DOI: https://doi.org/10.1378/chest.116.4.968
D’Agostino RB Sr, Pencina MJ, Massaro JM, et al. Cardiovascular disease risk assessment: insights from Framingham. Glob Heart 2013;8:11-23. DOI: https://doi.org/10.1016/j.gheart.2013.01.001
Webster AC, Nagler EV, Morton RL, et al. Chronic kidney disease. Lancet 2017;389:1238-52. DOI: https://doi.org/10.1016/S0140-6736(16)32064-5
Weng SF, Reps J, Kai J, et al. Can machine-learning improve cardiovascular risk prediction using routine clinical data? PLoS One 2017;12:e0174944. DOI: https://doi.org/10.1371/journal.pone.0174944
Kruppa J, Liu Y, Diener HC, et al. Probability estimation with machine learning methods for dichotomous and multicategory outcome: applications. Biom J 2014;56:564-83. DOI: https://doi.org/10.1002/bimj.201300077
Singal AG, Mukherjee A, Elmunzer BJ, et al. Machine learning algorithms outperform conventional regression models in predicting development of hepatocellular carcinoma. Am J Gastroenterol 2013;108:1723-30. DOI: https://doi.org/10.1038/ajg.2013.332
Horbinski C, Nabors LB, Portnow J, et al. NCCN guidelines® insights: central nervous system cancers, Version 2.2022. J Natl Compr Canc Netw 2023;21:12-20. DOI: https://doi.org/10.6004/jnccn.2023.0002
Niyazi M, Andratschke N, Bendszus M, et al. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol 2023;184:109663. DOI: https://doi.org/10.1016/j.radonc.2023.109663
Dharshinni NP, Azmi F, Fawwaz I, et al. Analysis of accuracy K-means and apriori algorithms for patient data clusters. J Phys Conf Ser 2019;1230:012020. DOI: https://doi.org/10.1088/1742-6596/1230/1/012020
Yadav R, Sharma A. Advanced methods to improve performance of K-means algorithm: a review. GJCST 2012;12:47-52.
Ghahramani Z. Probabilistic machine learning and artificial intelligence. Nature 2015;521:452-9. DOI: https://doi.org/10.1038/nature14541
Siddique S, Chow JCL. Artificial intelligence in radiotherapy. Rep Pract Oncol Radiother 2020;25:656-66. DOI: https://doi.org/10.1016/j.rpor.2020.03.015
Chang JY. Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol 2015;25:110-6. DOI: https://doi.org/10.1016/j.semradonc.2014.11.002
Chan C, Lang S, Rowbottom C, et al. Intensity-modulated radiotherapy for lung cancer: current status and future developments. J Thorac Oncol 2014;11:1598-608. DOI: https://doi.org/10.1097/JTO.0000000000000346
Yegya-Raman N, Zou W, Nie K, et al. Advanced radiation techniques for locally advanced non-small cell lung cancer: intensity-modulated radiation therapy and proton therapy. J Thorac Dis 2018;10:S2474-91. DOI: https://doi.org/10.21037/jtd.2018.07.29
How to Cite

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.