title: Local control with multimodality therapy for stage 4 neuroblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy of 21 Gy hyperfractionated radiotherapy for local control in conjunction with surgery and intensive systemic therapy for patients with Stage 4 neuroblastoma.
  
  
  METHODS
  After achieving a partial or complete remission, 47 children, ages 1-10 years, with Stage 4 neuroblastoma were treated on four consecutive institutional protocols (N4-N7) with dose-intensive multi-agent chemotherapy, maximal surgical debulking, and hyperfractionated radiotherapy (1.5 Gy twice a day to 21 Gy). Radiotherapy fields encompassed the initial tumor volume and regional lymph nodes plus a 3-cm margin. This was followed by consolidation with either autologous bone marrow transplantation (N4 and N5) or immunotherapy (N6 and N7).
  
  
  RESULTS
  Forty-five of 47 patients had a complete response to surgery and chemotherapy prior to radiotherapy. Five-year actuarial rates of local control, progression-free survival, and overall survival were 84%, 40%, and 45%, respectively. Among 26 patients who relapsed, 1 failed only at the primary site, 22 developed distant metastases exclusively, and 3 had both local and distant failures. There were no acute complications of radiotherapy.
  
  
  CONCLUSIONS
  Hyperfractionated radiotherapy to 21 Gy, in conjunction with dose-intensive systemic therapy and aggressive surgical resection, is well tolerated and is associated with durable local control for most patients with Stage 4 neuroblastoma.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. woldens@mskcc.org
authors.forename: S L
authors.initials: SL
authors.lastname: Wolden
authors.forename: S V
authors.initials: SV
authors.lastname: Gollamudi
authors.forename: B H
authors.initials: BH
authors.lastname: Kushner
authors.forename: M
authors.initials: M
authors.lastname: LaQuaglia
authors.forename: K
authors.initials: K
authors.lastname: Kramer
authors.forename: N
authors.initials: N
authors.lastname: Rosen
authors.forename: S
authors.initials: S
authors.lastname: Abramson
authors.forename: N V
authors.initials: NV
authors.lastname: Cheung
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000556:secondary / Q000601:surgery / Q000628:therapy*