title: Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology.
abstract: OBJECTIVE
  To determine the contribution of total body irradiation (TBI) to late sequelae in children treated with high-dose chemotherapy and autologous bone marrow transplantation for Stage IV neuroblastoma.
  
  
  METHODS
  We compared two populations that were similar with regard to age, stage, pre-autologous bone marrow transplantation chemotherapy (CT) regimen, period of treatment, and follow-up (12 years). The TBI group (n = 32) received TBI as part of the megatherapy procedure (1982-1993), whereas the CT group (n = 30) received conditioning without TBI (1985-1992). Analysis 12 years later focused on growth, weight and corpulence (body mass index) delay; hormonal deficiencies; liver, kidney, heart, ear, eye, and dental sequelae; school performance; and the incidence of secondary tumors.
  
  
  RESULTS
  Impact of TBI was most marked in relation to growth and weight delay, although the mean delay was not severe, probably because of treatment with growth hormones. Other consequences of TBI were thyroid insufficiency, cataracts, and a high incidence of secondary tumors. Hearing loss and dental agenesis were more prominent in the group treated with CT alone. No differences were observed in school performance.
  
  
  CONCLUSIONS
  The most frequent side effects of TBI were cataracts, thyroid insufficiency, and growth delay, but more worrying is the risk of secondary tumors. Because of the young mean age of patients and the toxicity of TBI regimens without any survival advantage, regimens without TBI are preferable in the management of Stage IV neuroblastoma.
authors.affiliation: Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Flandin
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartmann
authors.forename: Jean
authors.initials: J
authors.lastname: Michon
authors.forename: Ross
authors.initials: R
authors.lastname: Pinkerton
authors.forename: Carole
authors.initials: C
authors.lastname: Coze
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Stephan
authors.forename: Bernard
authors.initials: B
authors.lastname: Fourquet
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.forename: Christophe
authors.initials: C
authors.lastname: Bergeron
authors.forename: Thierry
authors.initials: T
authors.lastname: Philip
authors.forename: Christian
authors.initials: C
authors.lastname: Carrie
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015992:Body Mass Index; D001835:Body Weight / Q000528:radiation effects; D016026:Bone Marrow Transplantation; D002386:Cataract / Q000209:etiology; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D004522:Educational Status; D005260:Female; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage; D006128:Growth / Q000528:radiation effects; D013006:Growth Hormone / Q000172:deficiency; D006801:Humans; D007223:Infant; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology; D009447:Neuroblastoma / Q000628:therapy*; D012189:Retrospective Studies; D013963:Thyroid Hormones / Q000172:deficiency; D014916:Whole-Body Irradiation / Q000009:adverse effects*
chemical_list: D012739:Gonadal Steroid Hormones; D013963:Thyroid Hormones; D013006:Growth Hormone