室管膜瘤是儿童中第三常见的脑肿瘤。标准护理是手术后进行辅助放射治疗。文献中对于最佳放疗剂量仍​​存在争议。我们完成了系统回顾和荟萃分析，以确定儿科患者局部控制 (LC)、无事件生存 (EFS) 和总生存 (OS) 的最佳剂量。我们检索了 MEDLINE (PubMed)、Cochrane 系统数据库综述和 Web of Science 截止日期为 2024 年 1 月。我们纳入了队列研究，对患有非转移性颅内室管膜瘤的儿科患者（≤22 岁）进行 ≤54Gy 与 >54Gy 的辅助放疗进行比较。我们使用纽卡斯尔-渥太华队列研究质量评估量表评估研究质量。我们使用风险比 (HR)、95% 置信区间 (CI) 的随机效应荟萃分析来汇总研究，并通过 I2 评估统计异质性。当人力资源无法使用时，我们使用既定方法来转移风险。我们叙述性地总结了定性结果。七项研究符合我们的纳入标准，总共覆盖了 1321 名患者。研究包括 45-66.6Gy 的剂量范围。与>54Gy相比，我们发现接受≤54Gy的患者的LC（HR=0.83，95% CI 0.56-1.24，I2=49.1%）和EFS（HR=1.02，95% CI 0.95-1.09，I2= 0.00%）和 OS（HR=0.99，95% CI 0.82-1.20，I2=37.5%）。两项研究报告了按放疗剂量进行次全切除的情况，但两项研究均未报告 LC、EFS 或 OS 方面的统计差异，尽管患者数量较少（n≤30）。五项研究报告了后期影响，其中最常见的是脑干放射性坏死、辐射诱发的血管病变和继发性肿瘤。总体研究质量较高，但队列的可比性得分始终较低。没有关于分子亚组的研究报告。我们发现≤54Gy 治疗的患者与 >54Gy 治疗的患者在 LC、EFS 或 OS 方面没有差异。没有足够的数据来完成基于切除范围或分子亚组的放射治疗剂量的亚组荟萃分析。版权所有 © 2024。由 Elsevier Inc. 出版。

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.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.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.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.Copyright © 2024. Published by Elsevier Inc.