Comparative Efficacy of Treatments for Improving Progression-Free Survival Among Low Grade Glioma: A Systematic Review and Survival Network Meta-Analysis

<ns3:p>Background Low-grade gliomas (LGGs) are slow-growing primary brain tumors for which the optimal treatment to prolong progression-free survival (PFS) in adults remains debated. This network meta-analysis compares the efficacy of various treatment modalities for improving PFS in adult patients with LGG. Methods We systematically searched PubMed, Embase, and the Cochrane Library from inception to September 22, 2025 for studies evaluating PFS outcomes in adult LGG. Included studies were analyzed following PRISMA guidelines using a frequentist framework random-effects network meta-analysis with survival modeling. Results Seventeen trials involving 3,588 patients were included. Compared with biopsy alone, gross total resection with radiation (GTRR; HR = 0.47), subtotal resection with radiation and chemotherapy (STRRC; HR = 0.49), gross total resection alone (GTR; HR = 0.59), subtotal resection with chemotherapy (STRC; HR = 0.66), and subtotal resection with radiation (STRR; HR = 0.67) all significantly reduced progression risk (all p < 0.05). GTRR, STRRC, GTR, and STRC also outperformed subtotal resection alone (STR; HR = 0.57, 0.59, 0.70, and 0.79 respectively; all p < 0.05). SUCRA analysis ranked GTRR (84.7%) and STRRC (82.2%) as the most effective regimens. Conclusions These results demonstrate that combination therapies—particularly gross total resection with radiation or subtotal resection with radiation and chemotherapy—significantly improve PFS in adult LGG patients. PROSPERO registration number: CRD42023470802.</ns3:p>