Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.
Gustavo A Viani, Ana Carolina Hamamura, Caio Viani Arruda et al.
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In 30 seconds
This systematic review and meta-analysis compared proton with photon craniospinal irradiation (CSI) in children younger than 21 years with medulloblastoma. Ten cohort studies, including 1034 patients, were analysed; no randomised trials were available. Overall survival did not differ between modalities (RR: 0.984; 95 % CI: 0.902-1.073; p = 0.7118). Proton CSI was associated with lower risks of growth hormone deficiency and hypothyroidism, and less neurocognitive decline. Grade ≥ 3 ototoxicity did not differ, while grade ≤ 2 ototoxicity was more frequent with photon CSI.
Key findings
- Overall survival was similar with proton and photon CSI (RR: 0.984; 95 % CI: 0.902-1.073; p = 0.7118).
- Proton CSI was associated with reduced growth hormone deficiency (RR: 0.379; p < 0.001) and hypothyroidism (RR: 0.256; p < 0.001).
- Neurocognitive decline was lower with proton CSI (SMD: 0.708; p = 0.0001).
- Grade ≥ 3 ototoxicity did not differ (RR: 0.88; p = 0.5704); grade ≤ 2 ototoxicity was increased with photon CSI (RR: 1.15; p = 0.01).
Why it matters
Children treated for medulloblastoma may experience lasting endocrine, cognitive, and auditory effects. This synthesis suggests proton CSI may reduce several of these toxicities without an observed survival difference, making long-term outcomes an important consideration when comparing radiation modalities. The evidence is based on cohort studies, so the findings should be interpreted as comparative associations rather than definitive proof of benefit.
What to keep in mind
All included evidence came from cohort studies; no randomised trials were available. The authors call for prospective studies to confirm benefits and assess cost-effectiveness.