Excellent Local Control From Radiation Therapy for High-Risk Neuroblastoma

• Published in: International journal of radiation oncology, biology, physics Vol. 74; no. 5; pp. 1549 - 1554
• Main Authors: Gatcombe, Heather G., M.D, Marcus, R.B., M.D, Katzenstein, Howard M., M.D, Tighiouart, Mourad, Ph.D, Esiashvili, Natia, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2009
• Subjects: Abdominal Neoplasms - drug therapy; Abdominal Neoplasms - mortality; Abdominal Neoplasms - radiotherapy; Abdominal Neoplasms - surgery; Adolescent; Antineoplastic Agents - therapeutic use; Cancer; CHEMOTHERAPY; Child; Child, Preschool; CLINICAL TRIALS; Combined Modality Therapy - methods; CONTROL; Disease-Free Survival; Female; Gene Amplification; Genes, myc - genetics; HAZARDS; Hematology, Oncology and Palliative Medicine; High risk; Humans; Infant; Local control; Male; NEOPLASMS; Neuroblastoma; Neuroblastoma - mortality; Neuroblastoma - radiotherapy; Neuroblastoma - secondary; Neuroblastoma - therapy; PATIENTS; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - mortality; Pelvic Neoplasms - radiotherapy; Pelvic Neoplasms - surgery; Radiation; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Remission Induction; Retrospective Studies; Risk; SURGERY; Thoracic Neoplasms - drug therapy; Thoracic Neoplasms - mortality; Thoracic Neoplasms - radiotherapy; Thoracic Neoplasms - surgery; Young Adult; High risk; Neuroblastoma; Local control; Radiation
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.10.069

Purpose Local recurrence has been demonstrated in previous studies to be one of the obstacles to cure in neuroblastoma. Radiation therapy indications, optimal dose, and technique are still evolving. Here we report our experience of high-risk neuroblastoma patients who received local radiation therapy as part of their cancer management. Methods and Materials We conducted a retrospective study of 34 high-risk neuroblastoma patients who received radiation therapy to local sites of disease from March 2001 until February 2007 at our institution as part of their multimodality therapy. Results At a median follow-up of 33.6 months, 6 patients died of disease, 7 patients were alive with disease, and 21 patients were in clinical remission. Eleven patients relapsed, all distantly. Two patients failed locally in addition to distant sites. Both of these patients had persistent gross disease after induction chemotherapy and surgery. Our 3-year local control, event-free survival, overall survival were 94%, 66%, and 86%, respectively. Conclusion Patients with high-risk neuroblastoma in our series achieved excellent local control. Doses of 21–24 Gy to the primary tumor site appear to be adequate for local control for patients in the setting of minimal residual disease after induction chemotherapy and surgery. Patients with significant residual disease may benefit from radiation dose escalation, and this should be evaluated in a prospective clinical trial.