title: Relapse in the skull after myeloablative therapy for high-risk neuroblastoma.
abstract: Patterns of relapse were determined for 20 high-risk neuroblastoma patients treated with chemotherapy, surgery, primary and metastatic site radiation (21 Gray), myeloablative chemotherapy, peripheral blood stem cell rescue, and 13-cis-retinoic acid. The median follow-up duration after transplant is 21 months (range, 8-34 months). The event-free survival and overall survival at 2 years were 45 and 75%, respectively. There were 2 primary site recurrences. Metastatic sites that became MIBG-scan negative on induction chemotherapy were not irradiated. Four patients relapsed in irradiated metastatic sites, 3 in the skull, 1 in the liver. Failure also occurred at 2 skull sites treated with chemotherapy only, and at 5 new sites: 1 skull, 2 distant lymph nodes, and 2 bones other than skull. Eight of 20 patients had skull metastasis at presentation; 6 were irradiated and 3 were controlled. Skull metastasis warrants more aggressive evaluation and treatment.
authors.affiliation: Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA. pdesrosi@iupui.edu
authors.forename: D
authors.initials: D
authors.lastname: Sangthawan
authors.forename: P M
authors.initials: PM
authors.lastname: DesRosiers
authors.forename: M E
authors.initials: ME
authors.lastname: Randall
authors.forename: K
authors.initials: K
authors.lastname: Robertson
authors.forename: S
authors.initials: S
authors.lastname: Goebel
authors.forename: R
authors.initials: R
authors.lastname: Fallon
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009447:Neuroblastoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D012008:Recurrence; D018570:Risk Assessment; D012888:Skull Neoplasms / Q000556:secondary*; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D019653:Myeloablative Agonists; D005047:Etoposide; D016190:Carboplatin; D008558:Melphalan