Local control in metastatic neuroblastoma in children over 1 year of age

Abstract

BackgroundLocal control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age.MethodsFifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis.ResultsThe 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-53%) and 46% (95% CI 26-64%) respectively, while the 5-year PFS and OS for patients who did not receive RT were 22% (95% CI 9-38%) and 27% (95% CI 13-42%) respectively (P 0.02 for PFS). Multivariate analysis confirmed the role of well-known prognostic factors, such as the presence of MYCN amplification, age and response before high-dose chemotherapy.ConclusionsOur data suggest that the degree of resection does not influence survival in metastatic NBL patients treated with high-dose chemotherapy; local RT contributes to local disease control.

Local Control With 21-Gy Radiation Therapy for High-Risk Neuroblastoma

“…34,35 In fact, omission of radiation in patients with HR-NB who have undergone GTR has resulted in favorable local control rates in some studies 27,36 but not all. 3,37 Although there has been a decrease in life-threatening late effects with reduction in treatment exposure seen with childhood cancers such as Wilms and leukemia, there has been an increase in late mortality in neuroblastoma, attributed to the increase in therapeutic exposure. 38 With the primary goal of balancing outcomes with toxicity, and with the favorable rates of local control observed in our large cohort, we recommend dose reduction on protocol in patients with favorable prognostic factors, such as those who achieve GTR and do not have adverse biologic factors like MYCN amplification or LDH ≥1500 U/L.…”

Role of surgery in delayed local treatment for INSS 4 neuroblastoma

“…This is in agreement with Tajiri et al ., who reported that extirpation of the primary tumor without extensive surgery, similar to GTR/STR, might prevent local recurrence when combined radiation therapy is used for INSS 4 NB patients who have undergone radical operation after induction chemotherapy. Moreover, radical surgery did not contribute to improve OS in patients with metastatic NB, despite the fact that the patients underwent surgery immediately after conventional chemotherapy …”

“…Moreover, radical surgery did not contribute to improve OS in patients with metastatic NB, despite the fact that the patients underwent surgery immediately after conventional chemotherapy. 13 In the 1980s, the conventional treatment strategy (i.e. 30 Gy irradiation without HDC), was shown to improve prognosis.…”

Dosimetric comparison of tomotherapy and volumetric‐modulated arc therapy for children with neuroblastoma

“…Tomotherapy, Volumetric-modulated arc therapy, Neuroblastoma, Dosimetric comparison, Pediatric high-risk forms of the disease. [1][2][3] Radiotherapy constitutes a complex problem because of the shapes of the target volumes and the need to minimize the involvement of organs at risk (OARs). 4 In recent years, new radiotherapy technologies, such as volumetric-modulated arc therapy (VMAT) and helical tomotherapy (TOMO), have been widely used in the clinic.…”