Clinical results of proton beam therapy for advanced neuroblastoma

Oshiro, Yoshiko; Mizumoto, Masashi; Okumura, Toshiyuki; Sugahara, Shinji; Fukushima, Takashi; Ishikawa, Hitoshi; Nakao, Tomohei; Hashimoto, Takayuki; Tsuboi, Koji; Ohkawa, Hiroshi; Kaneko, Michio; Sakurai, Hideyuki

doi:10.1186/1748-717x-8-142

Cited by 35 publications

(21 citation statements)

References 21 publications

(20 reference statements)

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“…We did not exclude any patients with local failures occurring within 12 months. Our study adds to the scant proton literature and is consistent with the existing proton and photon literature with longer follow‐up . The predominant site of failure is progression in post‐induction non‐MIBG‐avid distant sites, similar to previously published reports .…”

Section: Discussionsupporting

confidence: 89%

“…At the University of Pennsylvania, all 11 children treated with proton therapy to the primary site were locally controlled at a median follow‐up of 16 months . In another study from Japan, 14 patients (8 high‐risk and 6 recurrent neuroblastoma) received proton therapy with a three‐year locoregional control rate of 82% . Compared with the above, our study has a longer median follow‐up of 60.2 months, with a larger number of patients, and looked at local control at both primary and irradiated metastatic sites.…”

Section: Discussionmentioning

confidence: 96%

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Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Bagley

Grosshans

Philip

et al. 2019

Pediatric Blood & Cancer

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Purpose Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. Methods and materials Eighteen patients with high‐risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post‐induction MIBG‐avid metastatic sites. Primary sites (n = 18) were treated to 21–36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21–24 Gy (RBE). Local control and survival rates were calculated using the Kaplan–Meier method. Results With a median follow‐up of 60.2 months, two‐ and five‐year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five‐year progression‐free survival (PFS) was 64%, and the five‐year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation‐related nephropathy or hepatopathy was reported. Conclusions Excellent local control was achieved using proton therapy to the primary and post‐induction MIBG‐positive distant sites. The predominant site of failure is progression in post‐induction non‐MIBG‐avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Bagley

Grosshans

Philip

et al. 2019

Pediatric Blood & Cancer

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“…In PBT, the tumor control rate is similar to that in photon radiotherapy [9][10][11][12][13][14][15][16][17][18][19][20], but late toxicity and the secondary cancer risk should be much lower due to the dose distribution [21]. For this reason, PBT has potential as a treatment for pediatric tumors, but fewer institutions have proton beam centers compared to those with normal photon radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Proton beam therapy for pediatric malignancies: a retrospective observational multicenter study in Japan

et al. 2016

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Recent progress in the treatment for pediatric malignancies using a combination of surgery, chemotherapy, and radiotherapy has improved survival. However, late toxicities of radiotherapy are a concern in long‐term survivors. A recent study suggested reduced secondary cancer and other late toxicities after proton beam therapy (PBT) due to dosimetric advantages. In this study, we evaluated the safety and efficacy of PBT for pediatric patients treated in Japan. A retrospective observational study in pediatric patients who received PBT was performed. All patients aged <20 years old who underwent PBT from January 1983 to August 2014 at four sites in Japan were enrolled in the study. There were 343 patients in the study. The median follow‐up periods were 22.6 months (0.4–374.3 months) for all patients and 30.6 months (0.6–374.3 months) for survivors. The estimated 1‐, 3‐, 5‐, and 10‐year survival rates were 82.7% (95% CI: 78.5–87.0%), 67.4% (61.7–73.2%), 61.4% (54.8–67.9%), and 58.7% (51.5–65.9%), respectively. Fifty‐two events of toxicity ≥ grade 2 occurred in 43 patients. Grade 4 toxicities of myelitis, visual loss (two cases), cerebral vascular disease, and tissue necrosis occurred in five patients. This study provides preliminary results for PBT in pediatric patients in Japan. More experience and follow‐up with this technique are required to establish the efficacy of PBT in this patient population.

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“…Proton beam radiation therapy has been shown to reduce the side effects of radiation therapy by minimizing doses of radiation delivered to normal tissues surrounding treated tumors [75]. Although the use of proton beam radiation in children with neuroblastoma has been hampered by both cost and limited access, early studies have suggested that proton beam radiation may provide some benefit to children with advanced neuroblastoma [76,77], and further studies are underway to better evaluate the safety and efficacy of proton beam radiation for children with neuroblastoma (NCT02112617).…”

Section: Local Controlmentioning

confidence: 99%

Overview and recent advances in the treatment of neuroblastoma

Whittle

Smith

Doherty

et al. 2017

Expert Review of Anticancer Therapy

312

258

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Introduction: Children with neuroblastoma have widely divergent outcomes, ranging from cure in >90% of patients with low risk disease to <50% for those with high risk disease. Recent research has shed light on the biology of neuroblastoma, allowing for more accurate risk stratification and treatment reduction in many cases, although newer treatment strategies for children with high-risk and relapsed neuroblastoma are needed to improve outcomes. Areas covered: Neuroblastoma epidemiology, diagnosis, risk stratification, and recent advances in treatment of both newly diagnosed and relapsed neuroblastoma. Expert commentary: The identification of newer tumor targets and of novel cell-mediated immunotherapy agents may lead to novel therapeutic approaches, and clinical trials for regimens designed to target individual genetic aberrations in tumors are underway. A combination of therapeutic modalities will likely be required to improve survival and cure rates for patients with high-risk neuroblastoma.ARTICLE HISTORY

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Clinical results of proton beam therapy for advanced neuroblastoma

Cited by 35 publications

References 21 publications

Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Proton beam therapy for pediatric malignancies: a retrospective observational multicenter study in Japan

Overview and recent advances in the treatment of neuroblastoma

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