Pan Lai-Sheng, Zhang Jing, Xiong Yu-Tong, Zhan Jin-Bo, Wang Qi-Yuan, Hong Tao
Jiangxi Key Laboratory of Neurological Diseases, Department of Neurosurgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China.
Pituitary. 2025 Sep 26;28(5):103. doi: 10.1007/s11102-025-01578-1.
According to existing epidemiological evidence, whether proton therapy is more efficacious and safe than photon therapy in the treatment of craniopharyngioma (CP) remains controversial. This study aimed to evaluate whether proton therapy exhibits better efficacy and safety in terms of survival outcomes and toxic effects than photon therapy.
An extensive search of pertinent articles published between 1990 and February 2025 was performed in the following four databases: PubMed, Web of Science, Embase, and the Cochrane Library. Original studies investigating the efficacy and safety of proton or photon therapy in patients with CP were included. This meta-analysis is reported following the PRISMA reporting guidelines, and data were pooled using a random effects model.
A total of 43 studies on 2784 patients were included in the meta-analysis. The pooled analysis favored proton therapy over photon therapy in terms of 3-year progression-free survival, 5-year progression-free survival, 5-year overall survival, 3-year local control and 5-year local control but not 3-year overall survival. In the safety analysis, compared with photon therapy, proton therapy was associated with reduced probabilities of visual, neurological, cognitive, and other miscellaneous toxicities, whereas the opposite trend was observed for endocrine toxicity. Subgroup analysis indicated that conventional radiation therapy had superior survival outcomes than stereotactic radiosurgery.
Compared with photon therapy, proton therapy may be associated with improved survival outcomes and reduced incidence of toxic effects in CP patients. Conventional radiation therapy appears to be more effective than stereotactic radiosurgery.
根据现有的流行病学证据，质子治疗在颅咽管瘤（CP）治疗中是否比光子治疗更有效和安全仍存在争议。本研究旨在评估质子治疗在生存结局和毒性方面是否比光子治疗具有更好的疗效和安全性。
在以下四个数据库中广泛检索1990年至2025年2月发表的相关文章：PubMed、科学网、Embase和Cochrane图书馆。纳入调查质子或光子治疗对CP患者疗效和安全性的原始研究。本荟萃分析按照PRISMA报告指南进行报告，并使用随机效应模型汇总数据。
荟萃分析共纳入43项关于2784例患者的研究。在3年无进展生存期、5年无进展生存期、5年总生存期、3年局部控制率和5年局部控制率方面，汇总分析支持质子治疗优于光子治疗，但在3年总生存期方面并非如此。在安全性分析中，与光子治疗相比，质子治疗与视觉、神经、认知和其他杂项毒性的发生率降低相关，而内分泌毒性则呈现相反趋势。亚组分析表明，传统放射治疗的生存结局优于立体定向放射外科手术。
与光子治疗相比，质子治疗可能与CP患者生存结局改善和毒性发生率降低相关。传统放射治疗似乎比立体定向放射外科手术更有效。
