Reassessing dose constraints of organs at risk in children with abdominal neuroblastoma treated with definitive radiation therapy: A correlation with late toxicity

Abstract

In children treated for abdominal neuroblastoma, the risk of developing clinically significant RT-related late toxicity of the kidney and liver is not appreciable, even when current DVH parameters for OARs are not achieved in planning. Toxicity outcomes did not necessarily correlate with present-day OAR dose constraints. Currently utilized DVH constraints are highly variable, and must be further studied and supported by toxicity outcomes to more accurately characterize risk of complications.

Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement

“…Although normal tissue constraints for organs at risk are not well defined or robustly supported by toxicity outcomes in the treatment of high-risk neuroblastoma (31), the dosimetric advantages of modern conformal techniques theoretically minimize the incidence of certain late effects. Intensity modulated RT seems superior in sparing kidney dose for midline neuroblastoma and may be capable of sparing vertebral bodies from the high-dose region, but this is at the expense of increased lower dose wash particularly to the liver, stomach, and spleen (32).…”

Late Toxicity After 3-Dimensional External Beam Radiotherapy Among Children With Cancer: A Systematic Review

“…The treatment period of the included studies varied between 1995 and 2014. Seven studies (53.8%) started inclusion before 2001 27,28,31,33–35,37…”

“…The administered target dose and daily doses varied. All studies described multimodal treatments, as expected in current clinical practice, although not all reports explicitly stated the proportion of eligible patients who received treatments other than radiotherapy; for details see Table 1 26–38…”

“…No study mentioned whether the outcome assessment was performed by an assessor who was blinded for the important determinants (type of radiotherapy, radiotherapy field, and radiotherapy dose). Therefore, in all 13 studies (100%), the risk of detection bias was considered unclear 26–38…”

“…None of the studies presented a multivariable risk factor analyses, therefore, this criterion was not applicable for all studies (100%) 26–38…”