Evidence map›Paper›PMID 42918935›Full record

ArticleJournal of neuro-oncology2026

Proton versus photon VMAT craniospinal irradiation: a retrospective comparison of toxicity and outcomes in solid tumor leptomeningeal carcinomatosis.

Gene Lamanilao, Brianna Hostler, Tam Le, Tara Austin, David Piccioni, Jessica Schulte, Rebecca Shatsky, Xiaojie Zhang, Heather Orosco, Iain MacEwan and 5 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Gene LamanilaoDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr. #0861, La Jolla, CA, 92093, USA.
Brianna HostlerDepartment of Psychology, San Diego State University, San Diego, CA, USA.
Tam LeSchool of Medicine, University of California San Diego, La Jolla, CA, USA.
Tara AustinDepartment of Psychiatry, University of California San Diego, La Jolla, CA, USA.
David PiccioniDepartment of Neurology, University of California San Diego, La Jolla, CA, USA.
Jessica SchulteDepartment of Neurology, NYU Langone Brain and Spine Tumor Center, New York, NY, USA.
Rebecca ShatskyDepartment of Medical Oncology, University of California San Diego, La Jolla, CA, USA.
Xiaojie ZhangDepartment of Medical Oncology, University of California San Diego, La Jolla, CA, USA.
Heather OroscoDepartment of Neurology, University of California San Diego, La Jolla, CA, USA.
Iain MacEwanCalifornia Protons Cancer Therapy Center, San Diego, CA, USA.
Jeffrey SteinbergDepartment of Neurosurgery, University of California San Diego, La Jolla, CA, USA.
Thomas BeaumontDepartment of Neurosurgery, University of California San Diego, La Jolla, CA, USA.
Victoria WuDepartment of Neurology, University of California San Diego, La Jolla, CA, USA.
Jona A Hattangadi-GluthDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr. #0861, La Jolla, CA, 92093, USA.
Kathryn R TringaleDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Dr. #0861, La Jolla, CA, 92093, USA. katringale@health.ucsd.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCraniospinal irradiation (CSI) is used for leptomeningeal carcinomatosis (LMC), yet comparative data between proton CSI (pCSI) and photon volumetric modulated arc therapy CSI (xCSI) are limited. We evaluated clinical outcomes and longitudinal toxicity profiles following pCSI versus xCSI in patients with solid tumor LMC.

methodsWe retrospectively identified adults with solid tumor LMC treated with CSI at a single institution from 2020 to 2025. Toxicities were graded per CTCAE v5.0 at baseline, during treatment, and at 1, 3, and 6 months post-CSI. Overall survival (OS) and central nervous system progression-free survival (CNS-PFS) were estimated using Kaplan-Meier methods; Cox models evaluated OS associations.

results45 patients initiated CSI (18 xCSI, 27 pCSI). Grade ≥ 3 lymphopenia during treatment was similar (75% xCSI versus 56% pCSI; p = 0.43), whereas Grade ≥ 3 thrombocytopenia occurred only with xCSI (29% versus 0%; p = 0.04). At 3 months, Grade ≥ 3 lymphopenia was higher with pCSI (79% versus 17%; p = 0.02). Non-hematologic Grade ≥ 3 toxicities were rare. OS did not significantly differ (median 8.5 months pCSI versus 4.8 months xCSI; p = 0.50), nor did CNS-PFS (5.9 versus 3.0 months; p = 0.20). On multivariable analysis, worse OS was associated with higher extracranial tumor burden (HR 2.77, 95% CI, 1.20-6.40) and performance status (HR 2.88, 95% CI, 1.01-8.23), but not modality.

conclusionNo statistically significant modality differences in OS or CNS-PFS were detected; baseline performance status and extracranial burden were associated with OS. VMAT-based CSI represents a practical alternative in settings without protons, with careful monitoring of acute hematologic toxicity.

Indexed as

Craniospinal IrradiationMeningeal CarcinomatosisPhotonsProton TherapyRadiotherapy, Intensity-ModulatedAdultAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRetrospective StudiesSurvival RateCraniospinal irradiationLeptomeningeal carcinomatosisLeptomeningeal metastasisProton therapySolid tumorsVolumetric modulated arc therapy

Identifiers

PMID42918935

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.