Intraoperative radiation therapy for relapsed or refractory high-risk neuroblastoma: A 27-year experience Journal Article
| Authors: | Conte, B.; Casey, D. L.; Tringale, K. R.; Honeyman, J.; Narayan, N. J. C.; LaQuaglia, M. P.; Gerstle, J. T.; Modak, S.; Kushner, B. H.; Kramer, K.; Wolden, S. L. |
| Article Title: | Intraoperative radiation therapy for relapsed or refractory high-risk neuroblastoma: A 27-year experience |
| Abstract: | Purpose: To evaluate outcomes after intraoperative radiation therapy (IORT) in high-risk neuroblastoma (NB), including local control, overall survival, and toxicity. Methods and Materials: This was a single institution retrospective study of 92 pediatric patients with NB treated with IORT from 1995 to 2022. Each IORT application was considered a separate event for a total of 110 sites treated. Local failure was calculated using the cumulative incidence function and survival by Kaplan-Meier method from the day of surgery. Results: All patients had high-risk relapsed or treatment refractory disease. Median age was 6 years (range, 2-34 years). Median follow-up for all patients and surviving patients was 16 months and 4 years, respectively. All patients previously received chemotherapy, 93% had prior external beam radiation therapy to the site of IORT (median dose, 21.6 Gy; range, 10-36 Gy), and 94% had a prior surgery for tumor resection. The median IORT dose was 12 Gy (range, 8-18 Gy) and median area treated was 18 cm2 (range, 2.5-60 cm2). The cumulative incidence of local failure was 23% at 2 years and 29% at 5 years. The overall survival (OS) was 44% at 2 years and 29% at 5 years. Local failure after IORT was associated with worse OS (hazard ratio, 1.74; 95% CI, 1.07-2.84; P = .0267). Toxicity from IORT was rare, with postoperative complications likely related to IORT seen in 7 (8%) patients. Conclusions: Our study represents the largest, most recent analysis of the efficacy and safety of IORT in patients with relapsed or refractory NB. Less than one-third of patients failed locally at 5 years, and achieving local control affected overall survival. Minimal toxicities directly related to IORT were observed. Overall, IORT is an effective and safe technique to achieve local control in high-risk relapsed or refractory neuroblastoma. © 2024 American Society for Radiation Oncology |
| Keywords: | adolescent; adult; cancer chemotherapy; cancer survival; child; controlled study; cancer surgery; treatment failure; major clinical study; overall survival; cancer recurrence; cancer patient; cancer radiotherapy; follow up; radiotherapy dosage; retrospective study; high risk patient; age; postoperative complication; confidence interval; neuroblastoma; hazard ratio; external beam radiotherapy; kaplan meier method; cancer control; intraoperative radiotherapy; cumulative incidence; radiation toxicity; refractory cancer; human; male; female; article |
| Journal Title: | Practical Radiation Oncology |
| Volume: | 14 |
| Issue: | 3 |
| ISSN: | 1879-8519 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-05-01 |
| Start Page: | e226 |
| End Page: | e232 |
| Language: | English |
| DOI: | 10.1016/j.prro.2023.12.008 |
| PUBMED: | 38310488 |
| PROVIDER: | scopus |
| PMCID: | PMC11948304 |
| DOI/URL: | |
| Notes: | Source: Scopus |
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