PMID- 36033525 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220830 IS - 2234-943X (Print) IS - 2234-943X (Electronic) IS - 2234-943X (Linking) VI - 12 DP - 2022 TI - Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis. PG - 893855 LID - 10.3389/fonc.2022.893855 [doi] LID - 893855 AB - BACKGROUND: Central 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. METHODS: A 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. RESULTS: Twenty-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%, I(2) = 94%) with photons and 1.5% (95% CI: 0%-4.5%, I(2) = 81%) with protons. The pooled incidence of all SNs was not different [photons: 3.6% (95% CI: 2.5%-4.8%, I(2) = 96%) vs. protons: 1.5% (95% CI: 0-4.5%, I(2) = 80%); p = 0.21]. CONCLUSION: We 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. CI - Copyright (c) 2022 Upadhyay, Yadav, Venkatesulu, Singh, Baliga, Raval, Lazow, Salloum, Fouladi, Mardis, Zaorsky, Trifiletti, Paulino and Palmer. FAU - Upadhyay, Rituraj AU - Upadhyay R AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. FAU - Yadav, Divya AU - Yadav D AD - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. FAU - Venkatesulu, Bhanu P AU - Venkatesulu BP AD - Department of Radiation Oncology, Loyola University, Chicago, IL, United States. FAU - Singh, Raj AU - Singh R AD - Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States. FAU - Baliga, Sujith AU - Baliga S AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. FAU - Raval, Raju R AU - Raval RR AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. FAU - Lazow, Margot A AU - Lazow MA AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. AD - Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States. FAU - Salloum, Ralph AU - Salloum R AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. AD - Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States. FAU - Fouladi, Maryam AU - Fouladi M AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. AD - Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States. FAU - Mardis, Elaine R AU - Mardis ER AD - Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States. FAU - Zaorsky, Nicholas G AU - Zaorsky NG AD - Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, United States. FAU - Trifiletti, Daniel M AU - Trifiletti DM AD - Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States. FAU - Paulino, Arnold C AU - Paulino AC AD - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. FAU - Palmer, Joshua D AU - Palmer JD AD - Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States. LA - eng PT - Systematic Review DEP - 20220812 PL - Switzerland TA - Front Oncol JT - Frontiers in oncology JID - 101568867 PMC - PMC9413159 OTO - NOTNLM OT - CNS radiation OT - pediatric cancer OT - photon OT - proton therapy OT - secondary Malignant Neoplasms after proton therapy vs photon therapy secondary cancer COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/08/30 06:00 MHDA- 2022/08/30 06:01 PMCR- 2022/01/01 CRDT- 2022/08/29 04:55 PHST- 2022/03/10 00:00 [received] PHST- 2022/07/21 00:00 [accepted] PHST- 2022/08/29 04:55 [entrez] PHST- 2022/08/30 06:00 [pubmed] PHST- 2022/08/30 06:01 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fonc.2022.893855 [doi] PST - epublish SO - Front Oncol. 2022 Aug 12;12:893855. doi: 10.3389/fonc.2022.893855. eCollection 2022.