质子治疗与光子治疗原发性中枢神经系统肿瘤后儿童发生继发性恶性肿瘤的风险：一项系统评价和荟萃分析。
Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis.
作者信息
Upadhyay Rituraj, Yadav Divya, Venkatesulu Bhanu P, Singh Raj, Baliga Sujith, Raval Raju R, Lazow Margot A, Salloum Ralph, Fouladi Maryam, Mardis Elaine R, Zaorsky Nicholas G, Trifiletti Daniel M, Paulino Arnold C, Palmer Joshua D
机构信息
Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
出版信息
Front Oncol. 2022 Aug 12;12:893855. doi: 10.3389/fonc.2022.893855. eCollection 2022.
BACKGROUND
Central nervous system tumors are now the most common primary neoplasms seen in children, and radiation therapy is a key component in management. Secondary malignant neoplasms (SMNs) are rare, but dreaded complications. Proton beam therapy (PBT) can potentially minimize the risk of SMNs compared to conventional photon radiation therapy (RT), and multiple recent studies with mature data have reported the risk of SMNs after PBT. We performed this systematic review and meta-analysis to characterize and compare the incidence of SMNs after proton and photon-based radiation for pediatric CNS tumors.
METHODS
A systematic search of literature on electronic (PubMed, Cochrane Central, and Embase) databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. We included studies reporting the incidence and nature of SMNs in pediatric patients with primary CNS tumors. The crude incidence of SMNs and all secondary neoplasms were separately extracted, and the random-effects model was used for pooled analysis and subgroup comparison was performed between studies using photons vs. protons.
RESULTS
Twenty-four studies were included for analysis. A total of 418 SMNs were seen in 38,163 patients. The most common SMN were gliomas (40.6%) followed by meningiomas (38.7%), sarcomas (4.8%), and thyroid cancers (4.2%). The median follow-up was 8.8 years [3.3-23.2].The median latency to SMN for photons and protons were 11.9 years [5-23] and 5.9 years [5-6.7], respectively. The pooled incidence of SMNs was 1.8% (95% CI: 1.1%-2.6%, I = 94%) with photons and 1.5% (95% CI: 0%-4.5%, I = 81%) with protons. The pooled incidence of all SNs was not different [photons: 3.6% (95% CI: 2.5%-4.8%, I = 96%) vs. protons: 1.5% (95% CI: 0-4.5%, I = 80%); p = 0.21].
CONCLUSION
We observed similar rates of SMN with PBT at 1.5% compared to 1.8% with photon-based RT for pediatric CNS tumors. We observed a shorter latency to SMN with PBT compared to RT. With increasing use of pencil beam scanning PBT and VMAT, further studies are warranted to evaluate the risk of secondary cancers in patients treated with these newer modalities.
背景
中枢神经系统肿瘤目前是儿童中最常见的原发性肿瘤，放射治疗是治疗的关键组成部分。继发性恶性肿瘤（SMN）虽然罕见，但却是可怕的并发症。与传统光子放射治疗（RT）相比，质子束治疗（PBT）有可能将SMN的风险降至最低，最近多项有成熟数据的研究报告了PBT后SMN的风险。我们进行了这项系统评价和荟萃分析，以描述和比较质子和光子放疗后小儿中枢神经系统肿瘤SMN的发生率。
方法
按照系统评价和荟萃分析的首选报告项目（PRISMA）方法，在电子数据库（PubMed、Cochrane Central和Embase）中对文献进行系统检索。我们纳入了报告原发性中枢神经系统肿瘤小儿患者SMN发生率和性质的研究。分别提取SMN和所有继发性肿瘤的粗发病率，并使用随机效应模型进行汇总分析，对使用光子与质子的研究进行亚组比较。
结果
纳入24项研究进行分析。38163例患者中共发现418例SMN。最常见的SMN是胶质瘤（40.6%），其次是脑膜瘤（38.7%）、肉瘤（4.8%）和甲状腺癌（4.2%）。中位随访时间为8.8年[3.3 - 23.2]。光子和质子放疗后发生SMN的中位潜伏期分别为11.9年[5 - 23]和5.9年[5 - 6.7]。光子放疗后SMN的汇总发生率为1.8%（95%CI：1.1% - 2.6%，I² = 94%），质子放疗后为1.5%（95%CI：0% - 4.5%，I² = 81%）。所有继发性肿瘤的汇总发生率无差异[光子放疗：3.6%（95%CI：2.5% - 4.8%，I² = 96%）与质子放疗：1.5%（95%CI：0 - 4.5%，I² = 80%）；p = 0.21]。
结论
我们观察到小儿中枢神经系统肿瘤采用PBT时SMN的发生率为1.5%，与基于光子的RT的1.8%相似。与RT相比，我们观察到PBT后发生SMN的潜伏期更短。随着笔形束扫描PBT和容积调强弧形放疗（VMAT）的使用增加，有必要进一步研究评估接受这些新治疗方式的患者发生继发性癌症的风险。
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