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

Abstract

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.

Proton Beam Therapy for Children With Neuroblastoma: Experiences From the Prospective KiProReg Registry

“…Our study complements the existing literature on children undergoing RT for NB confirming high LC and acceptable OS. Local control and survival rates were similar to other studies, which demonstrated a 3- to 5-year LC and OS of 64.7–97% and 35–94% ( 13 , 19 – 27 ). In the literature, the most common late effects associated with RT were musculoskeletal abnormalities, gastrointestinal dysfunctions, metabolic disorders, vascular changes, and secondary malignancies ( 22 , 28 – 31 ).…”

“…Planning studies in NB have shown that PBT can considerably reduce the radiation exposure of adjacent healthy tissue, potentially reducing the radiation-induced toxicities ( 11 , 12 ). Furthermore, there are already clinical data demonstrating the effectiveness and feasibility of PBT for NB patients ( 13 , 14 ). The current study reports on our experiences when treating patients with NB with special consideration of PBT in an intensive multimodal therapy concept.…”

Circular RNA DGKB Promotes the Progression of Neuroblastoma by Targeting miR-873/GLI1 Axis

“…Unfortunately, 40% of NB patients suffer from high-risk disease which is easy to relapse and lethal (1,4). Various kinds of therapeutic methods have been adopted to treat high-risk NB, including surgical treatment, chemotherapy, radiotherapy, immunotherapy, cis-retinoic acid, and proton therapy (5), but the prognosis of NB is still poor due to the complex mechanisms underlying NB occurrence and development. Therefore, it is urgent to further reveal the molecular mechanisms of NB in order to find novel and potent targets for the treatment of NB.…”

LIN28A gene polymorphisms modify neuroblastoma susceptibility: A four‐centre case‐control study

“…Patients with neuroblastoma can be classified into three risk groups: low risk, intermediate risk and high risk by using some clinical and biological prognostic factors. Patients with a non‐high risk (low and intermediate risk) of neuroblastoma have a long‐term survival rate up to of 90% or above, while those with high risk of neuroblastoma only achieve a survival rate as low as 40% …”

“…Patients with a non-high risk (low and intermediate risk) of neuroblastoma have a long-term survival rate up to of 90% or above, while those with high risk of neuroblastoma only achieve a survival rate as low as 40%. 10,11 In recent decades, remarkable advancement has been achieved in comprehending the fundamental aetiology of neuroblastoma. 12,13 Children's and pregnant women's exposures to many environmental factors were reported to predispose to neuroblastoma, yet the causality could not be finally confirmed.…”