Whole neuraxis irradiation to address central nervous system relapse in high-risk neuroblastoma Journal Article


Authors: Croog, V.; Kramer, K.; Cheung, N. K. V.; Kushner, B. H.; Modak, S.; Souweidane, M. M.; Wolden, S. L.
Article Title: Whole neuraxis irradiation to address central nervous system relapse in high-risk neuroblastoma
Abstract: Background: As systemic control of high-risk neuroblastoma (NB) has improved, relapse in the central nervous system (CNS) is an increasingly recognized entity that carries a grim prognosis. This study describes the use of craniospinal irradiation (CSI) for CNS relapse and compares outcomes to patients who received focal radiotherapy (RT). Methods: A retrospective query identified 29 children with NB treated at Memorial Sloan-Kettering Cancer Center since 1987 who received RT for CNS relapse. At CNS relapse, 16 patients received CSI (median dose, 2160cGy), and 13 received focal RT. Of those who underwent CSI, 14 (88%) received intra-Ommaya (IO) radioimmunotherapy (RIT); one patient in the non-CSI cohort received IO-RIT. Results: Patient characteristics were similar between the groups. Time to CNS relapse was 20 and 17 months for the CSI and non-CSI cohorts, respectively. At a median follow-up of 28 months, 12 patients (75%) in the CSI group are alive without CNS disease, including two patients with isolated skeletal relapse. Another patient is alive without disease after a brain relapse was retreated with RT. Three patients died - one with no NB at autopsy, one of CNS disease, and one of systemic disease. The two patients who died of NB did not receive IO-RIT. All 13 patients in the non-CSI cohort died at a median of 8.8 months. Conclusions: Low-dose CSI together with IO-RIT provides durable CNS remissions and improved survival compared with focal RT and conventional therapies. Further evaluation of long-term NB survivors after CSI is warranted to determine the treatment consequences for this cohort. © 2010 Elsevier Inc. All rights reserved.
Keywords: adolescent; cancer survival; child; clinical article; controlled study; preschool child; school child; treatment outcome; child, preschool; retrospective studies; bone metastasis; radiation dose; follow up; brain neoplasms; follow-up studies; radiotherapy; cohort analysis; retrospective study; central nervous system tumor; childhood cancer; high risk patient; central nervous system; cranial irradiation; time factors; irinotecan; iodine 131; infant; meningeal neoplasms; neuroblastoma; nerve fiber; irradiation; remission induction; focusing; cancer relapse; central nervous systems; radioimmunotherapy; neuroblastomas; pediatrics; spinal cord neoplasms; craniospinal irradiation; neuraxis; pediatric cancer
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 78
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2010-11-01
Start Page: 849
End Page: 854
Language: English
DOI: 10.1016/j.ijrobp.2009.09.005
PUBMED: 20207502
PROVIDER: scopus
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brian Kushner
    192 Kushner
  2. Nai-Kong Cheung
    447 Cheung
  3. Kim Kramer
    170 Kramer
  4. Shakeel Modak
    160 Modak
  5. Suzanne L Wolden
    424 Wolden
  6. Victoria Croog
    8 Croog