Li Yinuo, Mizumoto Masashi, Oshiro Yoshiko, Maruo Kazushi, Inaba Masako, Saito Takashi, Hosaka Sho, Iizumi Takashi, Fukushima Hiroko, Suzuki Ryoko, Nitta Hazuki, Shimizu Shosei, Nakai Kei, Sakurai Hideyuki
Department of Radiation Oncology, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan.
Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan.
Cancers (Basel). 2025 Jun 29;17(13):2191. doi: 10.3390/cancers17132191.
: PBT enables precise targeting of tumors, which reduces side effects on surrounding organs, with particularly significant benefits for pediatric tumors. However, the efficacy of PBT compared to photon RT for pediatric medulloblastoma is unclear. A meta-analysis to assess the efficacy of PBT vs. photon RT for this disease was performed. : Articles focusing on postoperative primary medulloblastoma from 1990 to 2022 were systematically reviewed and survival outcomes were extracted for medulloblastoma treated with PBT or photon RT. Meta-regression was used to identify predictive factors for treatment outcomes, including modality (PBT vs. photon RT), disease risk classification, gender, and age. : From 935 records, 18 articles were included (14 on photon RT, with 6 focusing on high-risk cases, and 4 on PBT). In standard-risk cases, the 1-, 3-, and 5-year overall survival (OS) rates were 95.5% (95% CI: 87.2-98.4%) vs. 96.7% (95% CI: 93.5-98.4%) ( = 0.1210); 89.8% (95% CI: 85.3-92.9%) vs. 88.0% (95% CI: 83.7-91.3%) ( = 0.5416); and 82.9% (95% CI: 76.6-87.6%) vs. 82.4% (95% CI: 77.2-86.5%) ( = 0.8313), respectively. For high-risk cases, the OS rates were 88.9% (95% CI: 85.5-91.6%); 73.6% (95% CI: 60.9-82.8%); and 68.6% (95% CI: 56.1-78.3%), respectively. The 1-, 3-, and 5-year progression-free survival (PFS) rates in standard-risk cases were 95.2% (95% CI: 91.8-97.2%) vs. 93.8% (95% CI: 89.4-96.5%) ( = 0.5275); 82.9% (95% CI: 77.3-87.2%) vs. 82.5% (95% CI: 80.1-84.7%) ( = 0.4294); and 79.6% (95% CI: 73.1-84.6%) vs. 77.0% (95% CI: 72.7-80.8%) ( = 0.3938), respectively. For high-risk cases, the PFS rates were 83.5% (95% CI: 77.0-88.3%); 64.8% (95% CI: 53.2-74.2%); and 60.4% (95% CI: 47.0-71.4%), respectively. Meta-regression analysis indicated no significant differences in 1- to 5-year OS and PFS between radiation modalities. Standard-risk cases were significantly associated with better OS and PFS. Younger age was significantly associated with 1- and 2-year OS and 1-year PFS, and male gender was significantly associated with 3-year OS and 3-year PFS. : Postoperative irradiation for pediatric medulloblastoma using PBT has a therapeutic effect comparable to that of photon RT. This suggests that PBT is a useful option among RT modalities for medulloblastoma.
质子束疗法（PBT）能够精确靶向肿瘤，减少对周围器官的副作用，这对儿童肿瘤尤其有益。然而，与光子放疗相比，PBT对儿童髓母细胞瘤的疗效尚不清楚。为此进行了一项荟萃分析，以评估PBT与光子放疗对该疾病的疗效。对1990年至2022年聚焦于术后原发性髓母细胞瘤的文章进行了系统回顾，并提取了接受PBT或光子放疗的髓母细胞瘤的生存结果。采用荟萃回归分析来确定治疗结果的预测因素，包括治疗方式（PBT与光子放疗）、疾病风险分类、性别和年龄。从935条记录中，纳入了18篇文章（14篇关于光子放疗，其中6篇聚焦于高危病例，4篇关于PBT）。在低危病例中，1年、3年和5年总生存率（OS）分别为95.5%（95%置信区间：87.2 - 98.4%）对96.7%（95%置信区间：93.5 - 98.4%）（P = 0.1210）；89.8%（95%置信区间：85.3 - 92.9%）对88.0%（95%置信区间：83.7 - 91.3%）（P = 0.5416）；以及82.9%（95%置信区间：76.6 - 87.6%）对82.4%（95%置信区间：77.2 - 86.5%）（P = 0.8313）。对于高危病例，OS率分别为88.9%（95%置信区间：85.5 - 91.6%）；73.6%（95%置信区间：60.9 - 82.8%）；以及68.6%（95%置信区间：56.1 - 78.3%）。低危病例中1年、3年和5年无进展生存率（PFS）分别为95.2%（95%置信区间：91.8 - 97.2%）对93.8%（95%置信区间：89.4 - 96.5%）（P = 0.5275）；82.9%（95%置信区间：77.3 - 87.2%）对82.5%（95%置信区间：80.1 - 84.7%）（P = 0.4294）；以及79.6%（95%置信区间：73.1 - 84.6%）对77.0%（95%置信区间：72.7 - 80.8%）（P = 0.3938）。对于高危病例，PFS率分别为83.5%（95%置信区间：77.0 - 88.3%）；64.8%（95%置信区间：53.2 - 74.2%）；以及60.4%（95%置信区间：47.0 - 71.4%）。荟萃回归分析表明，放疗方式之间1至5年的OS和PFS无显著差异。低危病例与更好的OS和PFS显著相关。年龄较小与1年和2年OS以及1年PFS显著相关，男性与3年OS和3年PFS显著相关。儿童髓母细胞瘤术后采用PBT放疗的治疗效果与光子放疗相当。这表明PBT是髓母细胞瘤放疗方式中的一个有用选择。
