A retrospective analysis of concurrent versus sequential chemoradiotherapy with tumor electric field therapy in Chinese high-grade glioma patients

A retrospective analysis of concurrent versus sequential chemoradiotherapy with tumor electric field therapy in Chinese high-grade glioma patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A retrospective analysis of concurrent versus sequential chemoradiotherapy with tumor electric field therapy in Chinese high-grade glioma patients Mengqi Sun, Qingsheng Zhang, Ying Wang, Zihuang Li, Yonggao Mou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8289162/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The optimal timing of Tumor Treating Fields (TTFields) with concurrent chemoradiotherapy (CRT) in high-grade glioma (HGG) remains unclear. This study compared survival and recurrence patterns between concurrent TTFields with CRT (CC-TTF) and sequential TTFields after CRT (S-TTF) in Chinese HGG patients. Methods: In this multi-center retrospective study, 114 HGG patients (70 CC-TTF, 44 S-TTF) treated between 2018-2023 were analyzed. Progression-free survival (PFS), overall survival (OS), and recurrence patterns were assessed using Kaplan-Meier methods, log-rank tests, and Cox regression. Results: The S-TTF group had a considerably longer median PFS (17.9 vs. 13.2 months, p=0.0175) and improved OS (33.4 vs. 21.6 months, p=0.1355) than the CC-TTF group for isocitrate dehydrogenase(IDH) wild-type patients. Recurrent IDH wild-type patients in the S-TTF group had better PFS (12.62 vs. 8.44 months, p=0.0363) and a longer OS (23.7 vs. 18.0 months, p=0.0666). Higher baseline Karnofsky Performance Status (KPS) scores (HR=0.66, p=0.0001) and longer TTFields duration (HR=0.95, p=0.0177) were found to be favorable prognostic factors for OS. However, delayed TTFields initiation (≥2.22 months post-diagnosis) was associated with increased distant progression (p = 0.0388). The recurrence patterns differed significantly between groups, with the S-TTF group having higher distant metastatic rates (34% vs. 26%). Conclusion: Sequential TTFields after CRT may increase PFS in IDH wild-type HGG patients compared to concurrent TTFields with CRT; however, OS advantages need to be validated. Distant recurrence was more prevalent with delayed TTFields commencement, indicating that timing affects illness development patterns. These findings lend support to future investigations aimed at optimizing TTFields inclusion into HGG therapy procedures. High-grade glioma TTFields concurrent chemoradiotherapy Sequential therapy Recurrence patterns IDH wild-type Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8289162","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560156864,"identity":"2a41dec5-6445-40ce-ba8a-c17eca7269f2","order_by":0,"name":"Mengqi Sun","email":"","orcid":"","institution":"Shenzhen People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mengqi","middleName":"","lastName":"Sun","suffix":""},{"id":560156865,"identity":"a451f271-350c-4704-a1d8-f829c0379f22","order_by":1,"name":"Qingsheng Zhang","email":"","orcid":"","institution":"Shenzhen People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qingsheng","middleName":"","lastName":"Zhang","suffix":""},{"id":560156866,"identity":"2d0aedee-824a-4169-83c2-e7f8f54767c5","order_by":2,"name":"Ying Wang","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Wang","suffix":""},{"id":560156877,"identity":"fd79c5d2-fd01-40d0-a665-b2102a05134e","order_by":3,"name":"Zihuang Li","email":"","orcid":"","institution":"Shenzhen People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zihuang","middleName":"","lastName":"Li","suffix":""},{"id":560156884,"identity":"73ecd1f0-923d-40cc-9780-b1803716461c","order_by":4,"name":"Yonggao Mou","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Yonggao","middleName":"","lastName":"Mou","suffix":""},{"id":560156892,"identity":"6e3f74cc-82f3-456f-9026-a30ec19029df","order_by":5,"name":"Yuanyuan Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYDACCTBpI0eyljRjkrUcTmwgWgf/7OZjj3nbmNPnz0h/JvGjhkHOvH8B4+cCfJbcOZZuzNvGlrvhRo6ZZM8xBmOZGw+YpWfg0WIgkWMmzdvGk7tBIodNmrGBIXGGxAE2Zh68WvK/AbVIpMsDHUasFqDhvG0GCQw3EswgWvgb8GuRuJFmJjnnXILhhjNvjC17jkkYS0gwNkvj08I/I/mZxJuy//Ly7ekPb/yosZGT4D988DM+LSDAxMsGJAUSwLYCERFxxPjjD8i+AzCLD+BWOgpGwSgYBSMSAAAcmUP+gB+01wAAAABJRU5ErkJggg==","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-12-05 15:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8289162/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8289162/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99392365,"identity":"778a6f45-a4d4-45b9-a8d3-f7fa7e709c88","added_by":"auto","created_at":"2026-01-02 13:54:29","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757138,"visible":true,"origin":"","legend":"","description":"","filename":"Cleanversion.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8289162/v1_covered_e2351fe1-a7aa-470f-b45e-49c2ac5cfa78.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A retrospective analysis of concurrent versus sequential chemoradiotherapy with tumor electric field therapy in Chinese high-grade glioma patients","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"High-grade glioma, TTFields, concurrent chemoradiotherapy, Sequential therapy, Recurrence patterns, IDH wild-type","lastPublishedDoi":"10.21203/rs.3.rs-8289162/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8289162/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: The optimal timing of Tumor Treating Fields (TTFields) with concurrent chemoradiotherapy (CRT) in high-grade glioma (HGG) remains unclear. This study compared survival and recurrence patterns between concurrent TTFields with CRT (CC-TTF) and sequential TTFields after CRT (S-TTF) in Chinese HGG patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this multi-center retrospective study, 114 HGG patients (70 CC-TTF, 44 S-TTF) treated between 2018-2023 were analyzed. Progression-free survival (PFS), overall survival (OS), and recurrence patterns were assessed using Kaplan-Meier methods, log-rank tests, and Cox regression.\u003c/p\u003e\n\u003cp\u003eResults: \u003cstrong\u003eThe\u003c/strong\u003e S-TTF group had a considerably longer median PFS (17.9 vs. 13.2 months, p=0.0175) and improved OS (33.4 vs. 21.6 months, p=0.1355) than the CC-TTF group for isocitrate dehydrogenase(IDH) wild-type patients. Recurrent IDH wild-type patients in the S-TTF group had better PFS (12.62 vs. 8.44 months, p=0.0363) and a longer OS (23.7 vs. 18.0 months, p=0.0666). Higher baseline Karnofsky Performance Status (KPS) scores (HR=0.66, p=0.0001) and longer TTFields duration (HR=0.95, p=0.0177) were found to be favorable prognostic factors for OS. However, delayed TTFields initiation (≥2.22 months post-diagnosis) was associated with increased distant progression (p = 0.0388). The recurrence patterns differed significantly between groups, with the S-TTF group having higher distant metastatic rates (34% vs. 26%).\u003c/p\u003e\n\u003cp\u003eConclusion:\u003cstrong\u003e Sequential\u003c/strong\u003e TTFields after CRT may increase PFS in IDH wild-type HGG patients compared to concurrent TTFields with CRT; however, OS advantages need to be validated. Distant recurrence was more prevalent with delayed TTFields commencement, indicating that timing affects illness development patterns. These findings lend support to future investigations aimed at optimizing TTFields inclusion into HGG therapy procedures.\u003c/p\u003e","manuscriptTitle":"A retrospective analysis of concurrent versus sequential chemoradiotherapy with tumor electric field therapy in Chinese high-grade glioma patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-15 21:51:33","doi":"10.21203/rs.3.rs-8289162/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00fa3be5-87ef-4298-acf9-dc758351dd85","owner":[],"postedDate":"December 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T13:54:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-15 21:51:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8289162","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8289162","identity":"rs-8289162","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}