Trial reportJAMA oncology2025
Proton Craniospinal Irradiation for Patients With Leptomeningeal Metastasis: A Randomized Clinical Trial.
Trial report in JAMA oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04343573 (A Phase II Randomized Study Assessing the Efficacy of Proton Craniospinal Irradiation), which is not on this map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Phase II Randomized Study Assessing the Efficacy of Proton Craniospinal Irradiation (CSI) vs Involved-field Photon Radiation Therapy for Leptomeningeal Metastases From Solid Tumor Malignancies
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Survival and hematologic toxicity after whole-brain radiotherapy, photon craniospinal irradiation, and proton craniospinal irradiation for solid-tumor leptomeningeal disease: a systematic review.Journal of neuro-oncology · 2026Pooled it
- The role of radiation therapy in leptomeningeal disease from breast cancer - a multicenter analysis.Clinical and translational radiation oncology · 2026Article
- Proton versus photon VMAT craniospinal irradiation: a retrospective comparison of toxicity and outcomes in solid tumor leptomeningeal carcinomatosis.Journal of neuro-oncology · 2026Article
- Right-sizing treatment for HER2-positive breast cancer: evolving algorithms across the disease continuum.Nature reviews. Clinical oncology · 2026Review
- The evolution of RTOG and NRG Oncology CNS tumors clinical trials.Journal of neuro-oncology · 2026Review
- Three-Discipline Collaborative Radiation Therapy (3DCRT) debate: Medical physics should focus less on geometric precision and more on biological outcomes.Journal of applied clinical medical physics · 2026Article
- Primary Intradural Extramedullary Ewing Sarcoma of the Thoracic Spine With Leptomeningeal and Brain Metastases: A Case Report and Literature Review.Brain tumor research and treatment · 2026Article
- Advances in the research on radiotherapy for lung cancer: a 2025 review.Translational lung cancer research · 2026Review
- Melanoma leptomeningeal disease: Advances in diagnosis and emerging therapeutic strategies.World journal of experimental medicine · 2026Review
- A meta-analysis of dose-volume parameters and treatment efficiency comparing O-ring and C-arm accelerator systems for craniospinal irradiations.Physics and imaging in radiation oncology · 2026Article
- Pathophysiology and treatment of leptomeningeal metastases in lung cancer.Translational lung cancer research · 2026Review
- Error in Figure 2.JAMA oncology · 2025Article
- Treatment decision-making for leptomeningeal metastasis after TKI resistance in EGFR-mutant lung cancer: a comprehensive review on staging, resistance patterns, and multimodal interventions.Frontiers in neurologyReview
Corrections and comments
- Commented on by
- Erratum issued
- Erratum issued
Authors and funding
24 authors.
Funding
Abstract
Importance: Leptomeningeal metastasis (LM) is associated with limited survival and few treatment options. Photon involved-field radiotherapy (IFRT) is the most common radiotherapy treatment for patients with LM from solid tumors. Objective: To assess whether proton craniospinal irradiation (pCSI) would result in superior central nervous system progression-free survival (CNS-PFS) compared with IFRT. Design, Setting, and Participants: A randomized, phase 2 trial of pCSI vs IFRT was conducted between April 16, 2020, and October 11, 2021, and included patients with non-small cell lung cancer and breast cancer with LM. Patients with other solid tumors were also enrolled in an exploratory pCSI cohort. Intervention: For the randomized groups, after stratifying by histology and systemic disease status, patients were assigned (2:1) to pCSI or IFRT. Main Outcomes and Measures: The primary end point was CNS-PFS. Secondary end points included overall survival (OS). Results: Of 98 total patients, 72 individuals (73.5%) were female, and the median (IQR) age was 59 (50-65) years. A total of 42 and 21 patients were randomly assigned to pCSI and IFRT, respectively. At planned interim analysis, a significant benefit in CNS-PFS was observed with pCSI compared with IFRT, leading to the early discontinuation of the trial. In this final analysis, a significant benefit was continually observed in CNS-PFS with pCSI (median, 8.2 months; 95% CI, 6.6-15.3) vs IFRT (median, 2.3 months; 95% CI, 1.2-4.0; P < .001). A statistically significant and clinically meaningful OS benefit with pCSI (median, 11.3 months; 95% CI, 7.5-18.3) vs IFRT (median, 4.9 months; 95% CI, 3.9-15.0; P = .04) was also observed. For the exploratory pCSI cohort (n = 35), the median CNS-PFS was 5.8 months (95% CI, 4.4-9.1) and OS was 7.0 months (95% CI, 5.4-10.6). Conclusions and Relevance: This randomized clinical trial that assessed the optimal radiotherapy treatment for LM found improved CNS-PFS and OS with pCSI compared with IFRT. The results suggest that pCSI should be considered when available. Trial Registration: ClinicalTrials.gov Identifier: NCT04343573.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.