目的:室管膜瘤是儿童第三大常见脑肿瘤。护理标准是手术后辅助放疗。文献中仍存在关于最佳放疗剂量的争议。我们完成了系统评价和荟萃分析,以确定局部控制(LC)的最佳剂量。无事件生存(EFS),儿科患者的总生存期(OS)。
方法:我们搜索了MEDLINE(PubMed),Cochrane系统评价数据库,和WebofScience到2024年1月。我们纳入了队列研究,比较了在非转移性颅内室管膜瘤的儿科患者(≤22岁)中≤54Gy和>54Gy的辅助放疗。我们使用队列研究的纽卡斯尔-渥太华质量评估量表评估研究质量。我们使用风险比(HR)的随机效应荟萃分析汇集了研究,95%置信区间(CI),并通过I2评估统计异质性。当HR不可用时,我们用既定的方法转化了风险。我们叙述性地总结了定性结果。
结果:七项研究符合我们的纳入标准,涵盖了1321名患者。研究包括45-66.6Gy的一系列剂量。与>54Gy相比,我们发现接受≤54Gy的患者的LC没有差异(HR=0.83,95%CI0.56-1.24,I2=49.1%),在EFS中(HR=1.02,95%CI0.95-1.09,I2=0.00%),和OS(HR=0.99,95%CI0.82-1.20,I2=37.5%)。两项研究报道了放疗剂量的次全切除,两项研究都没有报告LC的统计差异,EFS,或操作系统,尽管患者人数很少(n≤30)。五项研究报告了后期效应,脑干放射性坏死,放射性血管病变,继发性肿瘤是最常见的。总体研究质量高,尽管在队列的可比性中始终看到较低的分数。没有关于分子亚群的研究报道。
结论:我们发现LC没有差异,EFS,或OS为那些治疗≤54Gy与>54Gy相比。没有足够的数据来完成基于切除程度或分子亚组的放疗剂量的亚组荟萃分析。
OBJECTIVE: Ependymomas are the third most common brain tumors in children. Standard of care is surgery followed by adjuvant radiotherapy. Controversy in the literature still exists over optimal radiotherapy dose. We completed a systematic review and meta-analysis to determine the optimal dose for local control (LC), event-free survival (EFS), and overall survival (OS) in pediatric patients.
METHODS: We searched MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and Web of Science through January 2024. We included cohort studies that compared adjuvant radiotherapy of ≤54Gy to >54Gy in pediatric patients (≤22 years) with non-metastatic
intracranial ependymomas. We assessed study quality using the Newcastle-Ottawa Quality Assessment Scale of Cohort Studies. We pooled studies using a random effects meta-analysis for hazard ratios (HR), 95% confidence intervals (CI), and assessed statistical heterogeneity via I2. When HRs were unavailable, we transformed risks using established methods. We narratively summarized qualitative outcomes.
RESULTS: Seven studies met our inclusion criteria, covering a combined 1321 patients. Studies included a range of doses from 45-66.6Gy. Compared with >54Gy, we found no difference in LC for those receiving ≤54Gy (HR=0.83, 95% CI 0.56-1.24, I2=49.1%), in EFS (HR=1.02, 95% CI 0.95-1.09, I2=0.00%), and OS (HR=0.99, 95% CI 0.82-1.20, I2=37.5%). Two studies reported on subtotal resection by radiotherapy dose, neither study reporting statistical differences in LC, EFS, or OS, though the number of patients was small (n≤30). Five studies reported on late effects, with brainstem radionecrosis, radiation-induced vasculopathy, and secondary tumors being the most frequent. Overall study quality was high, though lower scores were consistently seen in comparability of cohorts. No studies reported on molecular subgroups.
CONCLUSIONS: We found no difference in LC, EFS, or OS for those treated with ≤54Gy compared to >54Gy. There was insufficient data to complete a subgroup meta-analysis on radiotherapy dosing based on extent of resection or molecular subgroups.