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Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.

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Title: Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.
Authors: Viani GA; Hospital 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. Electronic address: gustavo.viani@unesp.br., Hamamura AC; Hospital das Clínicas of Botucatu Medical School, University of State of São Paulo (UNESP), Botucatu, SP, Brazil., Arruda CV; Medical Physics at Radiocare, Oncolcinicas, Brazil., Cardoso CE; Master's Program in Applied Health Sciences at the University of Vassouras, Rio de Janeiro, Brazil., Salmon HA; Director of the Radiotherapy Department at the University of Vassouras. Rio de Janeiro, Brazil., Amaral GO; General Superintendent of FUSVE and Professor in the Business Administration Program at the University of Vassouras, Rio de Janeiro, Brazil.
Source: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2026 Oct; Vol. 223, pp. 111367. Date of Electronic Publication: 2026 Jan 11.
Publication Type: Comparative Study; Journal Article; Meta-Analysis; Systematic Review
Language: English
Journal Info: Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8407192 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0887 (Electronic) Linking ISSN: 01678140 NLM ISO Abbreviation: Radiother Oncol Subsets: MEDLINE
Imprint Name(s): Publication: Limerick : Elsevier Scientific Publishers
Original Publication: Amsterdam : Elsevier Science Publishers, c1983-
MeSH Terms: Cerebellar Neoplasms*/radiotherapy , Cerebellar Neoplasms*/mortality , Craniospinal Irradiation*/adverse effects , Craniospinal Irradiation*/methods , Medulloblastoma*/radiotherapy , Medulloblastoma*/mortality , Photons*/therapeutic use , Photons*/adverse effects , Proton Therapy*/adverse effects , Proton Therapy*/methods, Child ; Humans ; Treatment Outcome
Abstract: Objective: To compare the efficacy and toxicity of craniospinal irradiation (CSI) with proton (PBT) versus photon (PHT) therapy in pediatric patients with medulloblastoma, evaluating overall survival (OS), growth hormone deficiency (GHD), hypothyroidism, neurocognitive decline, and ototoxicity.
Materials and Methods: A systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Retrospective or prospective cohort studies comparing PBT versus PHT-CSI in children (<21 years) with medulloblastoma were included. Outcomes were OS, GHD, hypothyroidism, neurocognitive decline (full-scale IQ), and ototoxicity (grade ≥ 3). Data from 12 studies were extracted and analyzed using a fixed-effects model, calculating risk ratios (RR) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed with Cochran's Q test and I2 statistic.
Results: Ten cohort studies were included (no randomized trials), including 1034 patients (PBT = 537 and PHT = 497). No difference in OS was observed (RR: 0.984; 95 % CI: 0.902-1.073; p = 0.7118; I2 = 0 %). PBT significantly reduced GHD (RR: 0.379; p < 0.001, NNT = 2), hypothyroidism (RR: 0.256; p < 0.001, NNT = 2), and neurocognitive decline (SMD: 0.708; p = 0.0001, NNT = 5), with no difference in grade ≥ 3 ototoxicity (RR: 0.88; p = 0.5704). Grade ≤ 2 ototoxicity was increased with PHT (RR: 1.15; p = 0.01, NNT = 15).
Conclusion: PBT-CSI provides equivalent survival to PHT-CSI while significantly reducing GHD, hypothyroidism, mild ototoxicity, and neurocognitive toxicities in children with medulloblastoma. These findings support the preferential use of PBT to minimize long-term sequelae, though prospective studies are needed to confirm benefits and assess cost-effectiveness.
(Copyright © 2026 Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Medulloblastoma; Meta-analysis; Proton therapy; Radiotherapy; Survival
Entry Date(s): Date Created: 20260113 Date Completed: 20260924 Latest Revision: 20260925
Update Code: 20260926
DOI: 10.1016/j.radonc.2026.111367
PMID: 41529731
Database: MEDLINE
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  Data: Children&#39;s outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Viani+GA%22&quot;&gt;Viani GA&lt;/searchLink&gt;; Hospital das Cl&#237;nicas of Botucatu Medical School, University of State of S&#227;o Paulo (UNESP), Botucatu, SP, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Master&#39;s Program in Applied Health Sciences at the University of Vassouras, Rio de Janeiro, Brazil. Electronic address: gustavo.viani@unesp.br.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hamamura+AC%22&quot;&gt;Hamamura AC&lt;/searchLink&gt;; Hospital das Cl&#237;nicas of Botucatu Medical School, University of State of S&#227;o Paulo (UNESP), Botucatu, SP, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Arruda+CV%22&quot;&gt;Arruda CV&lt;/searchLink&gt;; Medical Physics at Radiocare, Oncolcinicas, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Cardoso+CE%22&quot;&gt;Cardoso CE&lt;/searchLink&gt;; Master&#39;s Program in Applied Health Sciences at the University of Vassouras, Rio de Janeiro, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Salmon+HA%22&quot;&gt;Salmon HA&lt;/searchLink&gt;; Director of the Radiotherapy Department at the University of Vassouras. Rio de Janeiro, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Amaral+GO%22&quot;&gt;Amaral GO&lt;/searchLink&gt;; General Superintendent of FUSVE and Professor in the Business Administration Program at the University of Vassouras, Rio de Janeiro, Brazil.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%228407192%22&quot;&gt;Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology&lt;/searchLink&gt; [Radiother Oncol] 2026 Oct; Vol. 223, pp. 111367. &lt;i&gt;Date of Electronic Publication: &lt;/i&gt;2026 Jan 11.
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  Data: &lt;i&gt;Publication&lt;/i&gt;: Limerick : Elsevier Scientific Publishers&lt;br /&gt;&lt;i&gt;Original Publication&lt;/i&gt;: Amsterdam : Elsevier Science Publishers, c1983-
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cerebellar+Neoplasms%22&quot;&gt;Cerebellar Neoplasms*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cerebellar+Neoplasms+radiotherapy%22&quot;&gt;radiotherapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cerebellar+Neoplasms%22&quot;&gt;Cerebellar Neoplasms*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cerebellar+Neoplasms+mortality%22&quot;&gt;mortality&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Craniospinal+Irradiation%22&quot;&gt;Craniospinal Irradiation*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Craniospinal+Irradiation+adverse+effects%22&quot;&gt;adverse effects&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Craniospinal+Irradiation%22&quot;&gt;Craniospinal Irradiation*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Craniospinal+Irradiation+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Medulloblastoma%22&quot;&gt;Medulloblastoma*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Medulloblastoma+radiotherapy%22&quot;&gt;radiotherapy&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Medulloblastoma%22&quot;&gt;Medulloblastoma*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Medulloblastoma+mortality%22&quot;&gt;mortality&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Photons%22&quot;&gt;Photons*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Photons+therapeutic+use%22&quot;&gt;therapeutic use&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Photons%22&quot;&gt;Photons*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Photons+adverse+effects%22&quot;&gt;adverse effects&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Proton+Therapy%22&quot;&gt;Proton Therapy*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Proton+Therapy+adverse+effects%22&quot;&gt;adverse effects&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Proton+Therapy%22&quot;&gt;Proton Therapy*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Proton+Therapy+methods%22&quot;&gt;methods&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%22&quot;&gt;Child&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Treatment+Outcome%22&quot;&gt;Treatment Outcome&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To compare the efficacy and toxicity of craniospinal irradiation (CSI) with proton (PBT) versus photon (PHT) therapy in pediatric patients with medulloblastoma, evaluating overall survival (OS), growth hormone deficiency (GHD), hypothyroidism, neurocognitive decline, and ototoxicity.&lt;br /&gt;Materials and Methods: A systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Retrospective or prospective cohort studies comparing PBT versus PHT-CSI in children (&amp;lt;21&#160;years) with medulloblastoma were included. Outcomes were OS, GHD, hypothyroidism, neurocognitive decline (full-scale IQ), and ototoxicity (grade&#160;≥&#160;3). Data from 12 studies were extracted and analyzed using a fixed-effects model, calculating risk ratios (RR) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed with Cochran&#39;s Q test and I2 statistic.&lt;br /&gt;Results: Ten cohort studies were included (no randomized trials), including 1034 patients (PBT&#160;=&#160;537 and PHT&#160;=&#160;497). No difference in OS was observed (RR: 0.984; 95&#160;% CI: 0.902-1.073; p&#160;=&#160;0.7118; I&lt;superscript&gt;2&lt;/superscript&gt;&#160;=&#160;0&#160;%). PBT significantly reduced GHD (RR: 0.379; p&#160;&amp;lt;&#160;0.001, NNT&#160;=&#160;2), hypothyroidism (RR: 0.256; p&#160;&amp;lt;&#160;0.001, NNT&#160;=&#160;2), and neurocognitive decline (SMD: 0.708; p&#160;=&#160;0.0001, NNT&#160;=&#160;5), with no difference in grade&#160;≥&#160;3 ototoxicity (RR: 0.88; p&#160;=&#160;0.5704). Grade&#160;≤&#160;2 ototoxicity was increased with PHT (RR: 1.15; p&#160;=&#160;0.01, NNT&#160;=&#160;15).&lt;br /&gt;Conclusion: PBT-CSI provides equivalent survival to PHT-CSI while significantly reducing GHD, hypothyroidism, mild ototoxicity, and neurocognitive toxicities in children with medulloblastoma. These findings support the preferential use of PBT to minimize long-term sequelae, though prospective studies are needed to confirm benefits and assess cost-effectiveness.&lt;br /&gt; (Copyright &#169; 2026 Elsevier B.V. All rights reserved.)
– Name: Abstract
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;Medulloblastoma; Meta-analysis; Proton therapy; Radiotherapy; Survival
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  Data: &lt;i&gt;Date Created: &lt;/i&gt;20260113 &lt;i&gt;Date Completed: &lt;/i&gt;20260924 &lt;i&gt;Latest Revision: &lt;/i&gt;20260925
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  Data: 20260926
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  Data: 10.1016/j.radonc.2026.111367
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  Data: 41529731
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=41529731
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      – Type: doi
        Value: 10.1016/j.radonc.2026.111367
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: 111367
    Subjects:
      – SubjectFull: Child
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Treatment Outcome
        Type: general
      – SubjectFull: Cerebellar Neoplasms radiotherapy
        Type: general
      – SubjectFull: Cerebellar Neoplasms mortality
        Type: general
      – SubjectFull: Craniospinal Irradiation adverse effects
        Type: general
      – SubjectFull: Craniospinal Irradiation methods
        Type: general
      – SubjectFull: Medulloblastoma radiotherapy
        Type: general
      – SubjectFull: Medulloblastoma mortality
        Type: general
      – SubjectFull: Photons therapeutic use
        Type: general
      – SubjectFull: Photons adverse effects
        Type: general
      – SubjectFull: Proton Therapy adverse effects
        Type: general
      – SubjectFull: Proton Therapy methods
        Type: general
    Titles:
      – TitleFull: Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.
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            – D: 01
              M: 10
              Text: 2026 Oct
              Type: published
              Y: 2026
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            – TitleFull: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
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