小儿颅内室管膜瘤光子放疗与质子束治疗的系统评价和荟萃分析：TRP-室管膜瘤2024。
Systematic review and meta-analysis of photon radiotherapy versus proton beam therapy for pediatric intracranial ependymoma: TRP-ependymoma 2024.
作者信息
Mizumoto Masashi, Hosaka Sho, Nakai Kei, Li Yinuo, Oshiro Yoshiko, Iizumi Takashi, Saito Takashi, Inaba Masako, Fukushima Hiroko, Suzuki Ryoko, Shimizu Shosei, Maruo Kazushi, Sakurai Hideyuki
机构信息
Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan.
Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan.
出版信息
Heliyon. 2024 Nov 14;10(22):e40372. doi: 10.1016/j.heliyon.2024.e40372. eCollection 2024 Nov 30.
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.
引言
质子束治疗（PBT）可能会减少儿童癌症患者治疗中的不良事件数量。然而，很难评估其实际治疗效果是否真的等同于光子放疗。为了比较光子放疗和PBT，我们进行了一项荟萃分析和系统评价。
方法
荟萃分析使用了1990年至2023年的论文，这些论文对小儿颅内室管膜瘤进行了术后局部光子放疗或PBT。根据作为局部照射的放疗给药情况，选择了15篇文章（5篇PBT，9篇光子放疗，1篇两者都有）。
结果
在所选的15篇文章中，1至5年总生存率（OS）（光子放疗与PBT）分别为95.4%（95%置信区间（CI）92.8 - 97.1%）对97.2%（95.7 - 98.2%）；88.3%（85.0 - 90.9%）对93.5%（91.4 - 95.1%）；81.2%（76.9 - 84.8%）对91.1%（88.4 - 93.2%）；76.9%（71.2 - 81.6%）对86.1%（81.9 - 89.4%）；以及73.8%（68.3 - 78.5%）对84.7%（79.9 - 88.5%）。1至5年局部控制率（LC）（光子放疗与PBT）分别为90.9%（95%CI 83.9 - 94.9%）对91.0%（88.7 - 92.9%）；81.5%（68.9 - 89.4%）对85.7%（82.0 - 88.6%）；77.3%（62.8 - 86.8%）对82.6%（79.1 - 85.5%）；74.6%（57.7 - 85.6%）对78.3%（71.6 - 83.5%）；以及72.6%（51.4 - 85.8%）对79.0%（73.4 - 83.5%）。荟萃回归分析确定了治疗方式（光子放疗与PBT）、照射时年龄、病理（2级与3级）以及肿瘤切除情况（完全切除与未切除）与PBT后3年OS显著更好以及较年轻患者1至5年LC更好之间的关系。
结论
在儿童室管膜瘤术后局部照射中，质子束治疗的效果与光子放疗相当。
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