Abstract:

Objective: To assess the efficacy and safety of the proton therapy for intracranial tumors in childhood.Methods: The electronic bibliographic databases were searched, including Cochrane library, PubMed, Embase, Web of science, Chinese Biomedical Database to assemble the studies of the proton therapy for the most common intracranial tumors in childhood.The MetaAnalyst Beta 3.13 and STATA 12.0 software were used to combine the extracted data. Results: Eleven studies were included, 9 case series reports and 2 case control studies, a total of 531 patients received proton therapy, including 2 of craniopharyngioma (45 patients), 2 of astrocytoma (59 patients), 5 of medulloblastoma (228 patients), 2 of ependymoma (120 patients), 1 report of no pathological type (79 patients). ①Overall survival (OS): There were 2, 3 and 5 years of OS in 5, 10 and 6 reports 2 case-control studies, 3 years OS proton therapy was 94.1% and 94%, photon therapy was 96.8% and 92.5%; 5 years OS of 1 report, proton therapy and photon therapy were 82% and 87.6%. The heterogeneity was found in case series reports of documents (I2＞50%, P＜0.1), by sub group random effects model with 2, 3 and 5 years of OS were 94%(95%CI:0.90-0.97), 90%(95%CI:0.86-0.93) and 87%(95%CI:0.82-0.93).②Local control rate (LC): there were 2, 3 and 5 years of LC in 3, 4 and 2 reports, The heterogeneity was found in case series reports of documents (I2＞50%, P＜0.1), by sub group random effects model with 2, 3 and 5 years of LC are 93% (95%CI:0.88-0.98) ,86% (95%CI:0.81-0.92) and 77% (95%CI:0.70-0.85). ③The second primary malignant tumor (SMN): 4 reported the SMN, only 1 patient of medulloblastoma induced acute myelogenous leukemia with PT and no patient in other reports. ④Toxicoty: 9 papers reported the toxicoties after PT. One paper was not hierarchical report, 16 patients of grade 3 above the level of hearing impairment and 6 patients of vascular injury, 16 patients of the endocrine dysfunction of replacement therapy were reported in 8 papers (465 patients).Conclusion: Available data demonstrated that the most common intracranial tumors in childhood are effectively and safely treated with proton therapy. Although current results are promiseing,more evidence is required before the proton therapy can become the standard threatment for intracranial tumors in childhood.