Background/Objectives: 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.Methods: 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.Results: 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%) (p= 0.1210); 89.8% (95% CI: 85.3–92.9%) vs. 88.0% (95% CI: 83.7–91.3%) (p= 0.5416); and 82.9% (95% CI: 76.6–87.6%) vs. 82.4% (95% CI: 77.2–86.5%) (p= 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%) (p= 0.5275); 82.9% (95% CI: 77.3–87.2%) vs. 82.5% (95% CI: 80.1–84.7%) (p= 0.4294); and 79.6% (95% CI: 73.1–84.6%) vs. 77.0% (95% CI: 72.7–80.8%) (p= 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.Conclusions: 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.
背景/目的：质子束治疗（PBT）能够精准靶向肿瘤，减少对周围器官的副作用，对儿童肿瘤尤其具有显著优势。然而，与光子放疗相比，PBT在儿童髓母细胞瘤治疗中的疗效尚不明确。本研究通过荟萃分析评估PBT与光子放疗对该疾病的疗效差异。 方法：系统回顾了1990年至2022年间针对术后原发性髓母细胞瘤的文献，提取采用PBT或光子放疗治疗的髓母细胞瘤患者的生存结局数据。采用元回归分析确定治疗结局的预测因素，包括治疗方式（PBT vs. 光子放疗）、疾病风险分级、性别和年龄。 结果：从935条记录中纳入18篇文献（光子放疗相关14篇，其中6篇聚焦高风险病例；PBT相关4篇）。在标危病例中，1年、3年和5年总生存率分别为：95.5%（95% CI: 87.2–98.4%）对比96.7%（95% CI: 93.5–98.4%）（p=0.1210）；89.8%（95% CI: 85.3–92.9%）对比88.0%（95% CI: 83.7–91.3%）（p=0.5416）；82.9%（95% CI: 76.6–87.6%）对比82.4%（95% CI: 77.2–86.5%）（p=0.8313）。高危病例的总生存率分别为：88.9%（95% CI: 85.5–91.6%）；73.6%（95% CI: 60.9–82.8%）；68.6%（95% CI: 56.1–78.3%）。标危病例的1年、3年和5年无进展生存率分别为：95.2%（95% CI: 91.8–97.2%）对比93.8%（95% CI: 89.4–96.5%）（p=0.5275）；82.9%（95% CI: 77.3–87.2%）对比82.5%（95% CI: 80.1–84.7%）（p=0.4294）；79.6%（95% CI: 73.1–84.6%）对比77.0%（95% CI: 72.7–80.8%）（p=0.3938）。高危病例的无进展生存率分别为：83.5%（95% CI: 77.0–88.3%）；64.8%（95% CI: 53.2–74.2%）；60.4%（95% CI: 47.0–71.4%）。元回归分析显示不同放疗方式在1-5年总生存率和无进展生存率上均无显著差异。标危病例与更好的总生存率和无进展生存率显著相关。较低年龄与1年、2年总生存率及1年无进展生存率显著相关，男性与3年总生存率和3年无进展生存率显著相关。 结论：儿童髓母细胞瘤术后采用PBT放疗的疗效与光子放疗相当。这表明在髓母细胞瘤的放疗方式选择中，PBT是一种有价值的治疗选项。
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