# Proton Beam Therapy Versus Photon Radiotherapy for Pediatric Neuroblastoma: A Systematic Review and Meta‐Analysis (TRP‐2025 Neuroblastoma)

## TL;DR

This study compares proton beam therapy and photon radiotherapy for pediatric neuroblastoma, finding similar survival rates but potential benefits from proton therapy in reducing long-term side effects.

## Contribution

The study provides a meta-analysis comparing survival outcomes of proton beam therapy and photon radiotherapy in pediatric neuroblastoma patients.

## Key findings

- PBT showed higher 1- and 2-year overall and progression-free survival rates compared to XRT.
- Treatment modality significantly influenced 2-year survival outcomes in the meta-regression analysis.
- Low rates of severe acute adverse events were observed in both treatment groups.

## Abstract

Radiotherapy (RT) is a standard component of treatment for high‐risk pediatric neuroblastoma. Proton beam therapy (PBT) offers dosimetric advantages over photon radiotherapy (XRT), but comparative clinical data remain limited.

As part of the review project at our facility, we conducted a systematic review and meta‐analysis comparing survival outcomes between PBT and XRT. PubMed was searched for studies published between 1990 and 2022. Eligible studies included those for pediatric patients with neuroblastoma receiving curative‐intent RT and reporting overall survival (OS) or progression‐free survival (PFS). A random‐effects meta‐analysis and meta‐regression were performed.

Eighteen studies (6 PBT, 12 XRT) were included. The 1‐ and 2‐year OS rates were 97.2% and 92.0% for PBT, and 89.1% and 81.3% for XRT. Corresponding PFS rates were 96.1% and 86.1% for PBT, and 78.6% and 64.5% for XRT. Meta‐regression identified treatment modality as a significant factor for 2‐year OS and PFS. However, variability in patient background and treatment protocols may have influenced the results. Limited toxicity data suggested low rates of grade ≥ 3 acute adverse events in both groups.

PBT gave survival outcomes that were at least comparable to XRT in pediatric neuroblastoma. Given its potential to reduce long‐term toxicity, PBT may be a reasonable alternative in selected cases. Further prospective studies are needed to validate these findings.