A systematic review and meta-analysis of x-ray therapy versus proton beam therapy for pediatric central nervous system germ cell tumors: TRP-Germinoma 2025.

Abstract

Introduction: Central nervous system germ cell tumors (CNS-GCTs) are rare pediatric tumors, categorized into germinomas and non-germinomatous germ cell tumors (NGGCTs). Proton-beam therapy (PBT) has been introduced as an alternative to X-ray therapy (XRT) for minimizing radiation exposure to normal brain tissue, but evidence comparing these treatment modalities is limited.

Methods: A systematic review and meta-analysis following PRISMA guidelines was conducted using PubMed for studies published between 1990 and 2022. Studies reporting overall survival (OS) and progression-free survival (PFS) for CNS-GCTs treated with PBT or XRT were included. Random-effects meta-analyses compared 3- and 5-year OS and PFS between treatment modalities.

Results: Forty-one studies were selected, with 36 on XRT and five on PBT. In germinoma patients, no significant differences were found between XRT and PBT for 3-year OS (95.3% vs 97.8%, p = 0.3158), 5-year OS (94.8% vs 97.8%, p = 0.3088), 3-year PFS (90.7% vs 97.1%, p = 0.1045), or 5-year PFS (89.2% vs 91.7%, p = 0.4676). The collected data were insufficient to evaluate PBT in NGGCTs.

Conclusion: PBT and XRT showed comparable survival outcomes in germinoma. Further research is required to explore PBT's potential benefits in preserving cognitive function or reducing secondary cancers.