Acta Neurochirurgica

, Volume 160, Issue 6, pp 1167–1174 | Cite as

Tumor-treating fields as a fourth treating modality for glioblastoma: a meta-analysis

  • Dimitrios E. Magouliotis
  • Eftihia K. Asprodini
  • Konstantina A. Svokos
  • Vasiliki S. Tasiopoulou
  • Alexis A. Svokos
  • Steven A. Toms
Original Article - Brain Tumors



We aim to review the available literature on patients suffering from glioblastoma treated with tumor-treating fields (TTFields) plus radio chemotherapy or conventional radio chemotherapy alone, to compare the efficacy and safety of the two methods.


A systematic literature search was performed in PubMed, Cochrane library, and Scopus databases, in accordance with the PRISMA guidelines. Six studies met the inclusion criteria incorporating 1806 patients for the qualitative analysis and 1769 for the quantitative analysis.


This study reveals increased median overall survival (weighted mean difference (WMD) 3.29 [95% confidence interval (CI) 2.37, 4.21]; p < 0.00001), survival at 1 year (odds ratio (OR) 1.81 [95% CI 1.41, 2.32]; p < 0.00001) and 2 years (OR 2.33 [95% CI 1.73, 3.14]; p < 0.00001), and median progression-free survival (WMD 2.35 [95% CI 1.76, 2.93]; p < 0.00001) along with progression-free survival at 6 months (WMD 6.86 [95% CI 5.91, 7.81]; p < 0.00001) for the patients treated with TTFields. Survival at 3 years was comparable between the two groups. TTFields were associated with fewer adverse events compared to chemotherapy along with similar incidence of skin irritation.


TTFields are a safe and efficient novel treatment modality. More randomized controlled studies, with longer follow-up, are necessary to further assess the clinical outcomes of TTFields.


Glioblastoma Tumor-treating fields TTFields Alternating electric fields Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Does not apply.

Supplementary material

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Table S1 (DOCX 64 kb)
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Fig. S1 (DOCX 484 kb)
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ESM 1 (DOC 63 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Hospital of LarissaLarissaGreece
  2. 2.Laboratory of Pharmacology, School of MedicineUniversity of ThessalyLarissaGreece
  3. 3.Department of Neurosurgery, The Warren Alpert Medical SchoolBrown UniversityProvidenceUSA
  4. 4.Faculty of MedicineUniversity of ThessalyLarissaGreece
  5. 5.Riverside Regional Medical CenterNewport NewsUSA

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