Intracystic bleomycin compared to intracystic radiotherapy with ³²P for cystic craniopharyngiomas in children

Patient or population: cystic craniopharyngiomas in children from birth to 18 years old
Setting: inpatients from 3 hospitals in China
Intervention: intracystic bleomycin
Comparison: intracystic radiotherapy with ³²P

Survival

‐

‐

‐

There was no information on overall survival and event‐free survival reported in this trial

Change in cyst size

MD ‐15% (‐69% to 39%)

7
(1 RCT)

⊕⊝⊝⊝
VERY LOW ¹

MD was 15% reduction in cyst size; the 95% CI mean a 69% reduction to a 39% increase in cyst size

Neurological status

Not estimable

Not estimable

⊕⊝⊝⊝
VERY LOW ¹

1 patient in the bleomycin group had left paralysis, while none of the patients in the ³²P group had severe sequelae. There was no significant difference between the 2 groups (Fisher's exact P value = 0.429).

Total number of adverse effects

RR 1.75
(0.68 to 4.53)

7
(1 RCT)

⊕⊝⊝⊝
VERY LOW ¹

Adverse effects including fever, 3rd nerve paralysis, headache and vomiting were included in this outcome measure

Fever

RR 2.92
(0.73 to 11.70)

7
(1 RCT)

⊕⊝⊝⊝
VERY LOW ¹

‐

3rd nerve paralysis

Not estimable

7
(1 RCT)

⊕⊝⊝⊝
VERY LOW ¹

1 patient in the ³²P group had 3rd nerve paralysis, while none of the patients in the bleomycin group suffered from this. There was no significant difference between the 2 groups (Fisher's exact P value = 1.00).

Headache and vomiting

Not estimable

7
(1 RCT)

⊕⊝⊝⊝
VERY LOW ¹

All 3 patients in the bleomycin group had headache and vomiting, while none of the patients in the ³²P group did. There was a significant difference in favour of the ³²P group (Fisher's exact P value = 0.029).

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; NA: not available; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect