Conflict of interest: Nothing to declare.
Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma†
Article first published online: 28 SEP 2012
Copyright © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 60, Issue 5, pages 761–765, May 2013
How to Cite
Pai Panandiker, A. S., Beltran, C., Billups, C. A., McGregor, L. M., Furman, W. L. and Davidoff, A. M. (2013), Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma. Pediatr. Blood Cancer, 60: 761–765. doi: 10.1002/pbc.24350
- Issue published online: 14 MAR 2013
- Article first published online: 28 SEP 2012
- Manuscript Accepted: 5 SEP 2012
- Manuscript Received: 16 JUL 2012
- local control;
Locoregional failure is a significant concern in patients with high-risk abdominal neuroblastoma (NB) receiving radiotherapy. Locoregional control outcomes were studied in children with NB receiving intensity modulated radiotherapy (IMRT).
Twenty children (11 females, 9 males) with NB (median age at diagnosis 3.4 years) receiving IMRT were analyzed for locoregional failure, outcomes, and toxicities. IMRT doses were 23.4 Gy (n = 12), 30 Gy (n = 1), 30.6 Gy (n = 5), and 36.0 Gy (n = 2) based on extent of resection. Five patients had tumors with MYCN amplification, and 19 had metastatic disease. All patients were treated consistently using reproducible immobilization techniques; physiological motion was assessed by 4D-CT, and target localization by cone-beam computed tomography. ICRU 62 volumetric conventions were employed based on institutional data for pediatric target volume and organ motion.
No patient developed primary site infield or locoregional failure at a median follow-up of 2.2 years. Distant failure (median time to distant failure 1.6 years) occurred in the brain, lungs, or skeletal sites in eight patients, five of whom died. The 2-year event-free survival was 58.5 ± 13.3% and cumulative incidence of local and distant failures was 0% and 41.5 ± 11.9%, respectively. Asymptomatic loose stool during RT occurred in nearly all patients, but required no intervention.
IMRT is feasible, safe in the short term, and yields excellent locoregional control. Despite subtotal resection in some cases, locoregional control appeared to be increased by conformal radiotherapy with ICRU 62-compliant volumes. Dose escalation beyond 30.6 Gy may be unnecessary with improved target volume coverage. Pediatr Blood Cancer 2013; 60: 761–765. © 2012 Wiley Periodicals, Inc.