Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology.
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.
Flandin
Isabelle
I
Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
Hartmann
Olivier
O
Michon
Jean
J
Pinkerton
Ross
R
Coze
Carole
C
Stephan
Jean Louis
JL
Fourquet
Bernard
B
Valteau-Couanet
Dominique
D
Bergeron
Christophe
C
Philip
Thierry
T
Carrie
Christian
C
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*
D012739:Gonadal Steroid Hormones; D013963:Thyroid Hormones; D013006:Growth Hormone