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脑膜母细胞瘤质子与光子脑脊髓放射疗法 (CURE) 的儿童结局:元分析

Gustavo A Viani¹, Ana Carolina Hamamura², Caio Viani Arruda³

¹Hospital das Clínicas of Botucatu Medical School, University of State of São Paulo (UNESP), Botucatu, SP, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Master's Program in Applied Health Sciences at the University of Vassouras, Rio de Janeiro, Brazil.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

|January 13, 2026

概括

质子束疗法 (PBT) 和光子疗法 (PHT) 在儿科脑髓母细胞瘤的生存率相似. PBT显著减少长期副作用,如生长激素缺乏和神经认知衰退,支持其优先使用.

科学领域:

儿科瘤学儿科瘤学
辐射瘤学辐射瘤学
医学物理医学物理

背景情况:

脑髓母细胞瘤是一种常见的儿科脑瘤,需要脊辐射 (CSI).
使用光子 (PHT) 的脊辐射 (CSI) 可以导致儿童的显著长期毒性.
质子束疗法 (PBT) 为周围组织提供了剂量减少的潜在替代方案.

研究的目的:

为了比较PBT-CSI与PHT-CSI在儿科骨髓母细胞瘤患者的疗效和毒性.
为了评估总生存 (OS),生长激素缺乏 (GHD),甲状腺功能低下,神经认知衰退和耳毒性方面的差异.

主要方法:

系统审查和元分析遵循PRISMA和Cochrane指南.
包括10项队列研究 (1034名儿科患者),比较PBT-CSI和PHT-CSI.
使用固定效应模型进行分析,计算风险比率 (RR) 和标准化平均差异 (SMD).

主要成果:

在PBT和PHT组之间,整体存活率 (OS) 没有显著差异 (RR:0.984,p=0.7118).
PBT显著降低了GHD (RR:0.379,p<0.001),甲状腺功能低下 (RR:0.256,p<0.001) 和神经认知衰退 (SMD:0.708,p=0.0001) 的发生率.
在严重的 (等级≥3) 耳毒性中没有差异,但PHT与增加的轻度 (等级≤2) 耳毒性有关 (RR:1.15,p=0.01).

结论:

PBT-CSI在儿科骨髓母细胞瘤中显示了与PHT-CSI相当的存活率.
PBT-CSI显著降低了GHD,甲状腺功能低下,轻度耳毒性和神经认知障碍的风险.
研究结果支持PBT作为一种首选的方法,以尽量减少儿科脑髓母细胞瘤患者的长期后果,这需要进一步的前性研究.

关键词:

中枢细胞瘤 (Medulloblastoma) 是一个进行元分析分析.质子疗法是一种质子疗法.辐射疗法辐射疗法幸存的生存方式

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