Intraoperative radiation therapy for high-risk pediatric neuroblastoma.
OBJECTIVE
To evaluate the efficacy of intraoperative radiation therapy (IORT) in the treatment of high-risk pediatric neuroblastoma.


METHODS
Between 1986 and 1998, 23 children received IORT for pediatric neuroblastoma. Electron beam energies ranged from 4 MeV to 16 MeV and median dose was 10 Gy (7-16 Gy).


RESULTS
Twenty-one of 23 patients were classified as high-risk. A gross total resection (GTR) was achieved in 18 patients, of whom 6 experienced disease recurrence, 2 of which included a locoregional relapse as a component of failure. Fourteen of 18 patients receiving IORT after a GTR are disease-free survivors. A second subset of 5 patients had a subtotal resection (STR), with gross residual disease remaining after surgery. All 5 patients recurred locally, and all died of their disease. IORT was extremely well-tolerated in our cohort. Surgical resection and IORT resulted in the narrowing of the abdominal aorta and an atrophic kidney in 1 patient.


CONCLUSIONS
For high-risk neuroblastoma patients, IORT as the only radiotherapy to the primary, produced excellent local control after a GTR. However, IORT as the sole radiotherapy to the primary was inadequate for patients with extensive adenopathy or an STR. In this setting, we are exploring the use of IORT as a boost in conjunction with external beam radiation therapy.
Haas-Kogan
D A
DA
Departments of Radiation Oncology, University of California, San Francisco, CA, USA. hkogan@radonc17.ucsf.edu
Fisch
B M
BM
Wara
W M
WM
Swift
P S
PS
Farmer
D L
DL
Harrison
M R
MR
Albanese
C
C
Weinberg
V
V
Matthay
K K
KK
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery
D000970:Antineoplastic Agents