Abstract
BACKGROUND: Craniopharyngiomas are complex tumors that can present significant challenges for neurosurgeons, sometimes necessitating a range of treatment modalities, including radiotherapy. MATERIAL AND METHODS: Through a systematic review and meta-analysis, this study evaluates the effectiveness and safety of proton beam therapy compared to traditional photon therapy for craniopharyngioma treatment. We searched major databases (Pubmed, Cochrane, and Scopus) for studies comparing proton and photon therapy for craniopharyngioma. Studies published up until April 2024 were included. We assessed event-free survival and endocrine dysfunction. The risk of bias in each study was evaluated. Pooled estimates of odds ratios using random-effects models were calculated for each outcome for patients undergoing proton versus photon therapies. RESULTS: This systematic review analyzed data from three non-randomized studies, encompassing 375 patients who received subtotal resection followed by radiation therapy for residual tumors. Patients were divided into two groups: photon therapy (n=147, 39.2%) and proton therapy (n=228, 60.8%). With a median follow-up of 5.0 to 6.4 years, the meta-analysis revealed no significant difference in event-free survival (log OR=-0.28, 95%CI=-1.49-0.93, p=0.65) or endocrine dysfunction (log OR=0.12, 95%CI=-0.36-0.60, p=0.62) between the proton and photon therapy groups. Heterogeneity among studies was low to moderate (I²=50.59% for event-free survival, I²=0.00% for endocrine dysfunction). CONCLUSION: This review suggests proton therapy offers comparable event-free survival and endocrine dysfunction to photon therapy for craniopharyngioma, which is especially relevant considering the substantial cost differential between these treatment options. However, further research with a greater sample size is warranted to confirm this survival outcome and explore long-term toxicity differences.