Review Article

Proton versus Photon Radiotherapy for Pediatric Central Nervous System Malignancies: A Systematic Review and Meta-Analysis of Dosimetric Comparison Studies

Table 1

Study selection criteria.

Inclusion criteriaExclusion criteria

Screening criteria: population
Pediatric and young adult patients (age < 21 years) affected by CNS neoplasms (craniopharyngioma, ependymoma, neuroblastoma, CNS germinoma, glioma, medulloblastoma, and primitive neuroectodermal tumors (PNETs))
Mixed populations (adults and pediatrics), or adults (age > 21)
Non-CNS malignancies

Screening criteria: study design
Dosimetric comparison between proton beam therapy and photon radiotherapy
Dosimetric studies comparing the most advanced/widespread irradiation techniques (protons versus photons)
Studies reporting single techniques and other particle therapy modalities
Reviews, clinical case reports/case series, cost-effective studies, simulation studies, preclinical models, etc.
Letters, editorials, congress abstracts, and guidelines

Screening criteria: outcomes
Dosimetric results for target, intracranial OARs (brainstem, cochlea, optic chiasm, hippocampus, normal brain tissue, pituitary gland, and Circle of Willis), and extracranial OARs (lens, retina, lacrimal glands, thyroid, esophagus, lungs, heart, liver, and kidneys)
Absence of reporting of dosimetric outcomes related to the target and/or the considered OARs

Eligibility criteria: outcome measures
Studies reporting any of the following parameters with average and standard deviation values:
(i) For OARs: Dmax for the brainstem, optic chiasm, normal brain tissue, pituitary gland, lens, retina, lacrimal gland, and esophagus and Dmean for the brainstem, cochlea, optic chiasm, hippocampus, normal brain tissue, pituitary gland, circle of Willis, lens, lacrimal gland, and other extracranial OARs
(ii) For target: Homogeneity Index and Conformity Index
Studies reporting other dosimetric parameters for target and OARs

Screening criteria: language
English
All other languages