Hyperfractionated Low-Dose (21 Gy) Radiotherapy for Cranial Skeletal Metastases in Patients With High-Risk Neuroblastoma Journal Article
| Authors: | Kushner, B. H.; Cheung, N. K. V.; Barker, C. A.; Kramer, K.; Modak, S.; Yataghene, K.; Wolden, S. L. |
| Article Title: | Hyperfractionated Low-Dose (21 Gy) Radiotherapy for Cranial Skeletal Metastases in Patients With High-Risk Neuroblastoma |
| Abstract: | Purpose: To present a large experience (73 patients) using a standard radiotherapy (RT) protocol to prevent relapse in cranial sites where measurable metastatic neuroblastoma (NB), an adverse prognostic marker, is common. Methods and Materials: High-risk NB patients with measurable cranial disease at diagnosis or residual cranial disease after induction therapy had those sites irradiated with hyperfractionated 21 Gy; a brain-sparing technique was used for an extensive field. The patients were grouped according to the response to systemic therapy. Thus, when irradiated, Group 1 patients were in complete remission and Group 2 patients had primary refractory disease. Follow-up was from the start of cranial RT. Results: At 3 years, the 39 Group 1 patients had a progression-free survival rate of 51%; control of cranial disease was 79%. Two relapses involved irradiated cranial sites. Two other patients relapsed in the irradiated cranial sites 6 and 12 months after a systemic relapse. At 3 years, the 34 Group 2 patients had a progression-free survival rate of 33%; control of cranial disease was 52%. Group 2 included 19 patients who had residual cranial (with or without extracranial) disease. The cranial sites showed major (n = 13), minor (n = 2), or no response (n = 4) to RT. Five patients had progression in the cranial RT field at 10-27 months. Group 2 also included 15 patients who had persistent NB in extracranial, but not cranial, sites. Of these 15 patients, 2 relapsed in the irradiated cranial sites and elsewhere at 8 and 14 months. Cranial RT was well tolerated, with no Grade 2 or greater toxicity. Conclusion: Hyperfractionated 21-Gy cranial RT might help control NB and is feasible without significant toxicity in children. © 2009 Elsevier Inc. All rights reserved. |
| Keywords: | cancer chemotherapy; cancer survival; controlled study; treatment response; disease-free survival; survival rate; young adult; unclassified drug; major clinical study; mortality; cisplatin; cancer risk; systemic therapy; bone metastasis; cancer radiotherapy; disease free survival; temozolomide; follow up; methodology; antineoplastic agent; cancer immunotherapy; cancer prevention; metastasis; progression free survival; neoplasm recurrence, local; radiotherapy; herpes zoster; stem cell transplantation; pathology; skull irradiation; cranial irradiation; irinotecan; monoclonal antibody; cancer regression; infant; neuroblastoma; minimal residual disease; neoplasm, residual; radiation dose fractionation; tumor recurrence; diagnosis; brain metastasis; radiopharmaceutical agent; remission; remission induction; cancer relapse; external beam radiotherapy; cancer control; toxicity; disease control; dose fractionation; fluorine containing polymers; alopecia; low energy radiation; radiation field; hearing loss; tooth disease; orbit tumor; orbital neoplasms; cranial metastases; hyperfractionated radiotherapy; radiotoxicity; induction therapy; low dose; neuroblastomas; monoclonal antibody 3f8; monoclonal antibody 3f8 i 131; spinal cord metastasis; skull tumor; skull neoplasms |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 75 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-11-15 |
| Start Page: | 1181 |
| End Page: | 1186 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2008.12.026 |
| PUBMED: | 19427746 |
| PROVIDER: | scopus |
| PMCID: | PMC5587173 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 30 November 2010" - "CODEN: IOBPD" - "Source: Scopus" |
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