Proton versus photon radiation therapy for pediatric medulloblastomas: a systematic review and meta-analysis.
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BACKGROUND: The rapid development of technologies that allow a more precise radiation-based treatment has constantly changed the current scenario of malignant central nervous system diseases. This study aimed to compare different complications and survival rates of pediatric patients with medulloblastomas treated with proton radiation therapy (PBRT) and photon radiation therapy (XRT). METHODS: We performed a systematic review and comparative meta-analysis. A total of 1319 studies were screened, and nine cohorts including 889 patients (509 PBRT and 380 XRT) were included. The primary endpoint was the overall survival in 5 years. Complications were analyzed separately. A random-effects model was used to calculate the odds ratios (ORs), with 95% confidence intervals (CIs) and a significance level of 5%. RESULTS: Primary endpoint overall 5-year survival showed no statistically significant difference between PBRT and XRT treatments (351 patients; OR 0.86 [0.46; 1.62] 95% CI; p = 0.73; I2 = 0%). Major complications also did not achieve statistically significant differences between groups (312 patients; OR0.82 [0.46; 1.46] 95% CI; p > 0.05; I2 = 12%). Minor complications, however, were significantly less likely in the PBRT group (528 patients; OR 0.11 [0.04; 0.31] 95% CI; p < 0.01; I2 = 78%). CONCLUSION: This systematic review and meta-analysis identified that the use of PBRT carries a lower likelihood of minor complications when compared to XRT for pediatric medulloblastomas. This suggests that PBRT can achieve comparable safety and effectiveness to XRT while delivering lower radiation doses to various tissues and organs.