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. 2024 Nov 14;10(22):e40372.
doi: 10.1016/j.heliyon.2024.e40372. eCollection 2024 Nov 30.

Systematic review and meta-analysis of photon radiotherapy versus proton beam therapy for pediatric intracranial ependymoma: TRP-ependymoma 2024

Masashi Mizumoto  1 , Sho Hosaka  2 , Kei Nakai  1 , Yinuo Li  1 , Yoshiko Oshiro  1   3 , Takashi Iizumi  1 , Takashi Saito  1 , Masako Inaba  2 , Hiroko Fukushima  2   4 , Ryoko Suzuki  4 , Shosei Shimizu  5 , Kazushi Maruo  6 , Hideyuki Sakurai  1
Affiliations

Systematic review and meta-analysis of photon radiotherapy versus proton beam therapy for pediatric intracranial ependymoma: TRP-ependymoma 2024

Masashi Mizumoto et al. Heliyon. .

Abstract

Introduction: Proton beam therapy (PBT) may reduce the number of adverse events in treatment of patients with pediatric cancer. However, it is difficult to evaluate whether the actual therapeutic effect is truly equivalent to that of photon radiotherapy. To compare photon radiotherapy and PBT, a meta-analysis and systematic review were performed.

Methods: The meta-analysis used papers from 1990 to 2023 in which postoperative local photon radiotherapy or PBT was performed for pediatric intracranial ependymomas. Fifteen articles (5 PBT, 9 photon radiotherapy, one both) were selected based on administration of radiotherapy as local irradiation.

Results: Among the 15 chosen articles, the 1- to 5-year overall survival (OS) rates (photon radiotherapy vs. PBT) were 95.4 % (95 % confidence interval (CI) 92.8-97.1 %) vs. 97.2 % (95.7-98.2 %); 88.3 % (85.0-90.9 %) vs. 93.5 % (91.4-95.1 %); 81.2 % (76.9-84.8 %) vs. 91.1 % (88.4-93.2 %); 76.9 % (71.2-81.6 %) vs. 86.1 % (81.9-89.4 %); and 73.8 % (68.3-78.5 %) vs. 84.7 % (79.9-88.5 %), respectively. The 1- to 5-year local control (LC) rates (photon radiotherapy vs. PBT) were 90.9 % (95 % CI 83.9-94.9 %) vs. 91.0 % (88.7-92.9 %); 81.5 % (68.9-89.4 %) vs. 85.7 % (82.0-88.6 %); 77.3 % (62.8-86.8 %) vs. 82.6 % (79.1-85.5 %); 74.6 % (57.7-85.6 %) vs. 78.3 % (71.6-83.5 %); and 72.6 % (51.4-85.8 %) vs. 79.0 % (73.4-83.5 %), respectively. The meta-regression analysis identified relationships of modality (photon radiotherapy vs. PBT), age at irradiation, pathology (Grade 2 vs. Grade 3), and tumor removal (complete resection vs. none) with significantly better 3-year OS after PBT and better 1- to 5-year LC at a younger age.

Conclusion: In postoperative local irradiation of ependymomas in children, proton beam therapy had outcomes comparable to those of photon radiotherapy.

Keywords: Brain; Ependymoma; Meta-analysis; Proton; Radiotherapy; Systematic review; TRP.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Manuscript selection process.
Fig. 2
Fig. 2
Forest plots of 1- to 5-year overall survival rate for proton beam therapy.
Fig. 3
Fig. 3
Forest plots of 1- to 5-year overall survival rate for photon radiotherapy.
Fig. 3
Fig. 3
Forest plots of 1- to 5-year overall survival rate for photon radiotherapy.
Fig. 4
Fig. 4
Forest plots of 1- to 5-year local control rate for proton beam therapy.
Fig. 5
Fig. 5
Forest plots of 1- to 5-year local control rate for photon radiotherapy.
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