Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis
BackgroundCentral nervous system tumors are now the most common primary neoplasms seen in children, and radiation therapy is a key component in management. Secondary malignant neoplasms (SMNs) are rare, but dreaded complications. Proton beam therapy (PBT) can potentially minimize the risk of SMNs co...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.893855/full |
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| author | Rituraj Upadhyay Divya Yadav Bhanu P. Venkatesulu Raj Singh Sujith Baliga Raju R. Raval Margot A. Lazow Margot A. Lazow Ralph Salloum Ralph Salloum Maryam Fouladi Maryam Fouladi Elaine R. Mardis Nicholas G. Zaorsky Daniel M. Trifiletti Arnold C. Paulino Joshua D. Palmer |
| author_facet | Rituraj Upadhyay Divya Yadav Bhanu P. Venkatesulu Raj Singh Sujith Baliga Raju R. Raval Margot A. Lazow Margot A. Lazow Ralph Salloum Ralph Salloum Maryam Fouladi Maryam Fouladi Elaine R. Mardis Nicholas G. Zaorsky Daniel M. Trifiletti Arnold C. Paulino Joshua D. Palmer |
| author_sort | Rituraj Upadhyay |
| collection | DOAJ |
| description | BackgroundCentral nervous system tumors are now the most common primary neoplasms seen in children, and radiation therapy is a key component in management. Secondary malignant neoplasms (SMNs) are rare, but dreaded complications. Proton beam therapy (PBT) can potentially minimize the risk of SMNs compared to conventional photon radiation therapy (RT), and multiple recent studies with mature data have reported the risk of SMNs after PBT. We performed this systematic review and meta-analysis to characterize and compare the incidence of SMNs after proton and photon-based radiation for pediatric CNS tumors.MethodsA systematic search of literature on electronic (PubMed, Cochrane Central, and Embase) databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. We included studies reporting the incidence and nature of SMNs in pediatric patients with primary CNS tumors. The crude incidence of SMNs and all secondary neoplasms were separately extracted, and the random-effects model was used for pooled analysis and subgroup comparison was performed between studies using photons vs. protons.ResultsTwenty-four studies were included for analysis. A total of 418 SMNs were seen in 38,163 patients. The most common SMN were gliomas (40.6%) followed by meningiomas (38.7%), sarcomas (4.8%), and thyroid cancers (4.2%). The median follow-up was 8.8 years [3.3–23.2].The median latency to SMN for photons and protons were 11.9 years [5-23] and 5.9 years [5-6.7], respectively. The pooled incidence of SMNs was 1.8% (95% CI: 1.1%–2.6%, I2 = 94%) with photons and 1.5% (95% CI: 0%–4.5%, I2 = 81%) with protons. The pooled incidence of all SNs was not different [photons: 3.6% (95% CI: 2.5%–4.8%, I2 = 96%) vs. protons: 1.5% (95% CI: 0–4.5%, I2 = 80%); p = 0.21].ConclusionWe observed similar rates of SMN with PBT at 1.5% compared to 1.8% with photon-based RT for pediatric CNS tumors. We observed a shorter latency to SMN with PBT compared to RT. With increasing use of pencil beam scanning PBT and VMAT, further studies are warranted to evaluate the risk of secondary cancers in patients treated with these newer modalities. |
| first_indexed | 2024-12-10T19:58:20Z |
| format | Article |
| id | doaj.art-ce041456ad0c47a18b4f44251e442435 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T19:58:20Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-ce041456ad0c47a18b4f44251e4424352022-12-22T01:35:36ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.893855893855Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysisRituraj Upadhyay0Divya Yadav1Bhanu P. Venkatesulu2Raj Singh3Sujith Baliga4Raju R. Raval5Margot A. Lazow6Margot A. Lazow7Ralph Salloum8Ralph Salloum9Maryam Fouladi10Maryam Fouladi11Elaine R. Mardis12Nicholas G. Zaorsky13Daniel M. Trifiletti14Arnold C. Paulino15Joshua D. Palmer16Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, Loyola University, Chicago, IL, United StatesDepartment of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesDepartment of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United StatesDepartment of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United StatesDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, United StatesDepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United StatesBackgroundCentral nervous system tumors are now the most common primary neoplasms seen in children, and radiation therapy is a key component in management. Secondary malignant neoplasms (SMNs) are rare, but dreaded complications. Proton beam therapy (PBT) can potentially minimize the risk of SMNs compared to conventional photon radiation therapy (RT), and multiple recent studies with mature data have reported the risk of SMNs after PBT. We performed this systematic review and meta-analysis to characterize and compare the incidence of SMNs after proton and photon-based radiation for pediatric CNS tumors.MethodsA systematic search of literature on electronic (PubMed, Cochrane Central, and Embase) databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. We included studies reporting the incidence and nature of SMNs in pediatric patients with primary CNS tumors. The crude incidence of SMNs and all secondary neoplasms were separately extracted, and the random-effects model was used for pooled analysis and subgroup comparison was performed between studies using photons vs. protons.ResultsTwenty-four studies were included for analysis. A total of 418 SMNs were seen in 38,163 patients. The most common SMN were gliomas (40.6%) followed by meningiomas (38.7%), sarcomas (4.8%), and thyroid cancers (4.2%). The median follow-up was 8.8 years [3.3–23.2].The median latency to SMN for photons and protons were 11.9 years [5-23] and 5.9 years [5-6.7], respectively. The pooled incidence of SMNs was 1.8% (95% CI: 1.1%–2.6%, I2 = 94%) with photons and 1.5% (95% CI: 0%–4.5%, I2 = 81%) with protons. The pooled incidence of all SNs was not different [photons: 3.6% (95% CI: 2.5%–4.8%, I2 = 96%) vs. protons: 1.5% (95% CI: 0–4.5%, I2 = 80%); p = 0.21].ConclusionWe observed similar rates of SMN with PBT at 1.5% compared to 1.8% with photon-based RT for pediatric CNS tumors. We observed a shorter latency to SMN with PBT compared to RT. With increasing use of pencil beam scanning PBT and VMAT, further studies are warranted to evaluate the risk of secondary cancers in patients treated with these newer modalities.https://www.frontiersin.org/articles/10.3389/fonc.2022.893855/fullsecondary Malignant Neoplasms after proton therapy vs photon therapy secondary cancerproton therapyCNS radiationpediatric cancerphoton |
| spellingShingle | Rituraj Upadhyay Divya Yadav Bhanu P. Venkatesulu Raj Singh Sujith Baliga Raju R. Raval Margot A. Lazow Margot A. Lazow Ralph Salloum Ralph Salloum Maryam Fouladi Maryam Fouladi Elaine R. Mardis Nicholas G. Zaorsky Daniel M. Trifiletti Arnold C. Paulino Joshua D. Palmer Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis Frontiers in Oncology secondary Malignant Neoplasms after proton therapy vs photon therapy secondary cancer proton therapy CNS radiation pediatric cancer photon |
| title | Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis |
| title_full | Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis |
| title_fullStr | Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis |
| title_full_unstemmed | Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis |
| title_short | Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis |
| title_sort | risk of secondary malignant neoplasms in children following proton therapy vs photon therapy for primary cns tumors a systematic review and meta analysis |
| topic | secondary Malignant Neoplasms after proton therapy vs photon therapy secondary cancer proton therapy CNS radiation pediatric cancer photon |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.893855/full |
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