A systematic review and meta-analysis with focus on radiotherapy of pediatric standard-risk medulloblastoma: New strategies are needed to improve survival and reduce side-effects
Abstract
We explored the impact of different radiotherapy (RT) treatment modalities and prescriptions on outcomes for standard risk pediatric medulloblastoma patients (MB-SR). A systematic review and meta-analysis were performed. Primary MB-SR patients, aged 3-21 years treated with cranio-spinal axis and tumor boost RT during 1995-2024 were included. Data on progression-free and overall survival outcomes (PFS and OS) and side-effects were extracted. Trial efforts for MB-SR have focused on mitigation of side-effects through de-escalation of RT, with practically unchanged PFS and OS during the past 30 years. The three major changes firstly reduced radiation dose to the cranio-spinal axis, secondly reduced boost volume from the entire posterior fossa to only the tumor volume with margin and finally the importance of increased conformity. Sixteen different studies and 2002 patients were included in pooled random-effects models, revealing a 5-year PFS and OS of 76.9 % and 83.8 %, respectively. However, new strategies are needed to further improvement of survival and reduced side-effects.
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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