Hyperfractionated low-dose radiotherapy for high-risk neuroblastoma after intensive chemotherapy and surgery Journal Article

Authors: Kushner, B. H.; Wolden, S.; LaQuaglia, M. P.; Kramer, K.; Verbel, D.; Heller, G.; Cheung, N. K. V.
Article Title: Hyperfractionated low-dose radiotherapy for high-risk neuroblastoma after intensive chemotherapy and surgery
Abstract: Purpose: To assess prognostic factors for local control in high-risk neuroblastoma patients treated with hyperfractionated 21-Gy total dose to consolidate remission achieved by dose-intensive chemotherapy and surgery. Patients and Methods: Patients with high-risk neuroblastoma in first remission received local radiotherapy (RT) totaling 21 Gy in twice-daily 1.5-Gy fractions. RT to the primary site followed dose-intensive chemotherapy and tumor resection; the target field encompassed the extent of tumor at diagnosis, plus 3-cm margins and regional lymph nodes. RT to distant sites followed radiologic evidence of response. Local failure was correlated with clinical factors (including other consolidative treatments) and biologic findings. Results: Of 99 consecutively irradiated patients followed for a median of 21.1 months from RT, 10 relapsed in or at margins of RT fields at 1 to 27 months (median, 14 months). At 36 months after RT, the probability of primary-site failure was 10.1% ± 5.3%. No primary-site relapses occurred among the 23 patients whose tumors were excised at diagnosis, but there were three such relapses among the seven patients who were irradiated with evidence of residual disease in the primary site. Four of 18 patients with MYCN-amplified disease and serum lactate dehydrogenase greater than 1,500 U/L had local failures (23.4% ± 10.7% risk at 18 months). Acute radiotoxicities were insignificant, but three of 35 patients followed for ≥ 36 months had short stature from decreased growth of irradiated vertebra. Conclusion: Hyperfractionated 21-Gy RT is well tolerated and, together with dose-intensive chemotherapy and surgery, may help in local control of high-risk neuroblastoma. Extending the RT field to definitively encompass regional nodal groups may improve results. Visible residual disease may warrant higher RT dosing. Patients with biologically unfavorable disease may be at increased risk for local failure. RT to the primary site may not be necessary when tumors are excised at diagnosis. © 2001 by American Society of Clinical Oncology.
Keywords: adolescent; adult; child; treatment outcome; child, preschool; survival analysis; cancer surgery; treatment failure; major clinical study; cisplatin; doxorubicin; cancer combination chemotherapy; multimodality cancer therapy; cancer radiotherapy; radiotherapy, adjuvant; antineoplastic agent; lymphatic metastasis; neoplasm staging; neoplasm recurrence, local; etoposide; antineoplastic combined chemotherapy protocols; risk factors; cyclophosphamide; vincristine; monoclonal antibody; cancer regression; infant; neuroblastoma; radiation dose fractionation; genes, myc; dose fractionation; correlation function; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 19
Issue: 11
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2001-06-01
Start Page: 2821
End Page: 2828
Language: English
PUBMED: 11387353
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus
MSK Authors
  1. Brian Kushner
    190 Kushner
  2. Glenn Heller
    295 Heller
  3. Nai-Kong Cheung
    439 Cheung
  4. Kim Kramer
    168 Kramer
  5. Suzanne L Wolden
    419 Wolden
  6. David A Verbel
    20 Verbel
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