Local control with 21-Gy radiotherapy for high-risk neuroblastoma

Publication date: Available online 27 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dana L. Casey, Brian H. Kushner, Nai-Kong V. Cheung, Shakeel Modak, Michael P. LaQuaglia, Suzanne L. Wolden
PurposeThe optimal dose of radiation in high-risk neuroblastoma is unknown. We sought to evaluate local control following 21-Gy radiotherapy (RT) to the primary site in patients with high-risk neuroblastoma.Patients and MethodsAfter receiving dose-intensive chemotherapy and gross total resection (GTR), 246 patients (ages 1.2-17.9, median 4.0 years) with high-risk neuroblastoma underwent RT to the primary site at xxx from 2000-2014. RT consisted of 21 Gy in twice-daily fractions of 1.5 Gy each. Local failure (LF) was correlated with biologic prognostic factors and clinical findings at the time of diagnosis and start of RT.ResultsMedian follow-up of surviving patients was 6.4 years. Cumulative incidence of LF was 7.1% at 2 years post-RT and 9.8% at 5 years post-RT. The isolated LF rate was 3.0%. Eighty-six percent of all local failures were within the RT field. Local control was worse in patients who required more than one surgical resection to achieve GTR (22.4% vs 8.3%, p=0.01). There was also a trend towards inferior local control with MYCN-amplified tumors or serum LDH ≥1500 U/L (p=0.09 and p=0.06 respectively).ConclusionAfter intensive chemotherapy and maximal surgical debulking, hyperfractionated RT with 21 Gy in high-risk neuroblastoma results in excellent local control. Given the young patient age, concern for late effects, and local control >90%, dose-reduction may be appropriate for patients without MYCN amplification who achieve GTR.



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