Hyperfractionated Low-Dose (21 Gy) Radiotherapy for Cranial Skeletal Metastases in Patients With High-Risk Neuroblastoma

• Published in: International journal of radiation oncology, biology, physics Vol. 75; no. 4; pp. 1181 - 1186
• Main Authors: Kushner, Brian H., M.D, Cheung, Nai-Kong V., M.D., Ph.D, Barker, Christopher A., M.D, Kramer, Kim, M.D, Modak, Shakeel, M.D, Yataghene, Karima, M.D, Wolden, Suzanne L., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.11.2009
• Subjects: Adolescent; BODY; BRAIN; CENTRAL NERVOUS SYSTEM; Child; Child, Preschool; Cranial Irradiation - adverse effects; Cranial Irradiation - methods; Cranial metastases; Disease-Free Survival; DISEASES; Dose Fractionation; Female; Hematology, Oncology and Palliative Medicine; Humans; Hyperfractionated radiotherapy; Infant; Male; MEDICINE; METASTASES; Neoplasm Recurrence, Local - radiotherapy; Neoplasm, Residual; NERVOUS SYSTEM; Neuroblastoma; Neuroblastoma - drug therapy; Neuroblastoma - mortality; Neuroblastoma - radiotherapy; Neuroblastoma - secondary; NUCLEAR MEDICINE; Orbital Neoplasms - drug therapy; Orbital Neoplasms - mortality; Orbital Neoplasms - radiotherapy; Orbital Neoplasms - secondary; ORGANS; Prognosis; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotoxicity; Remission Induction; SKELETON; SKULL; Skull Neoplasms - drug therapy; Skull Neoplasms - mortality; Skull Neoplasms - radiotherapy; Skull Neoplasms - secondary; Survival Rate; THERAPY; Young Adult; Cranial metastases; Hyperfractionated radiotherapy; Radiotoxicity; Prognosis; Neuroblastoma
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.12.026

Purpose To present a large experience (73 patients) using a standard radiotherapy (RT) protocol to prevent relapse in cranial sites where measurable metastatic neuroblastoma (NB), an adverse prognostic marker, is common. Methods and Materials High-risk NB patients with measurable cranial disease at diagnosis or residual cranial disease after induction therapy had those sites irradiated with hyperfractionated 21 Gy; a brain-sparing technique was used for an extensive field. The patients were grouped according to the response to systemic therapy. Thus, when irradiated, Group 1 patients were in complete remission and Group 2 patients had primary refractory disease. Follow-up was from the start of cranial RT. Results At 3 years, the 39 Group 1 patients had a progression-free survival rate of 51%; control of cranial disease was 79%. Two relapses involved irradiated cranial sites. Two other patients relapsed in the irradiated cranial sites 6 and 12 months after a systemic relapse. At 3 years, the 34 Group 2 patients had a progression-free survival rate of 33%; control of cranial disease was 52%. Group 2 included 19 patients who had residual cranial (with or without extracranial) disease. The cranial sites showed major ( n = 13), minor ( n = 2), or no response ( n = 4) to RT. Five patients had progression in the cranial RT field at 10–27 months. Group 2 also included 15 patients who had persistent NB in extracranial, but not cranial, sites. Of these 15 patients, 2 relapsed in the irradiated cranial sites and elsewhere at 8 and 14 months. Cranial RT was well tolerated, with no Grade 2 or greater toxicity. Conclusion Hyperfractionated 21-Gy cranial RT might help control NB and is feasible without significant toxicity in children.