Impact of radiotherapy for high-risk neuroblastoma: a Children's Cancer Group study.
OBJECTIVE
To assess the effect of local radiation administered to primary disease sites in children with high-risk neuroblastoma.


METHODS
A total of 539 eligible patients were entered on protocol CCG-3891, consisting of chemotherapy, primary surgery, and 10 Gy of external beam radiation therapy (EBRT) to gross residual disease, followed by randomized assignment to continuation chemotherapy (CC) or autologous bone marrow transplantation (ABMT). ABMT patients received total body irradiation (TBI).


RESULTS
Estimated event-free survival and overall survival at 5 years were 25% +/- 2% and 35% +/- 2%, respectively. Estimated 5-year locoregional recurrence rates were 51% +/- 5% and 33% +/- 7% for CC and ABMT patients (p = 0.004). For patients who received 10 Gy of EBRT to the primary, the addition of 10 Gy of TBI and ABMT decreased local recurrence compared with CC (22% +/- 12% and 52% +/- 8%, p = 0.022). EBRT did not increase acute toxicity, except for increased total parenteral nutrition administration.


CONCLUSIONS
In combination with EBRT to the primary tumor site, the addition of 10 Gy of TBI as a component of high-dose chemotherapy with ABMT improved local control compared with CC without TBI. Results suggest a dose-response relationship for local EBRT. Short-term toxicity of local EBRT is limited.
Haas-Kogan
Daphne A
DA
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA. hkogan@radonc17.ucsf.edu
Swift
Patrick S
PS
Selch
Michael
M
Haase
Gerald M
GM
Seeger
Robert C
RC
Gerbing
Robert B
RB
Stram
Daniel O
DO
Matthay
Katherine K
KK
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D006402:Hematologic Diseases / Q000139:chemically induced; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D007223:Infant; D015474:Isotretinoin / Q000627:therapeutic use; D015993:Life Tables; D009364:Neoplasm Recurrence, Local; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D009447:Neuroblastoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012074:Remission Induction; D012306:Risk; D016019:Survival Analysis; D015996:Survival Rate; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation / Q000009:adverse effects
D000970:Antineoplastic Agents; D004317:Doxorubicin; D003520:Cyclophosphamide; D015474:Isotretinoin; D002945:Cisplatin