title: Long-term outcome and toxicities of intraoperative radiotherapy for high-risk neuroblastoma.
abstract: OBJECTIVE
  To review a historical cohort of consecutively accrued patients with high-risk neuroblastoma treated with intraoperative radiotherapy (IORT) to determine the therapeutic effect and late complications of this treatment.
  
  
  METHODS
  Between 1986 and 2002, 31 patients with newly diagnosed high-risk neuroblastoma were treated with IORT as part of multimodality therapy. Their medical records were reviewed to determine the outcome and complications. Kaplan-Meier probability estimates of local control, progression-free survival, and overall survival at 36 months after diagnosis were recorded.
  
  
  RESULTS
  Intraoperative radiotherapy to the primary site and associated lymph nodes achieved excellent local control at a median follow-up of 44 months. The 3-year estimate of the local recurrence rate was 15%, less than that of most previously published series. Only 1 of 22 patients who had undergone gross total resection developed recurrence at the primary tumor site. The 3-year estimate of local control, progression-free survival, and overall survival was 85%, 47%, and 60%, respectively. Side effects attributable to either the disease process or multimodality treatment were observed in 7 patients who developed either hypertension or vascular stenosis. These late complications resulted in the death of 2 patients.
  
  
  CONCLUSIONS
  Intraoperative radiotherapy at the time of primary resection offers effective local control in patients with high-risk neuroblastoma. Compared with historical controls, IORT achieved comparable control and survival rates while avoiding many side effects associated with external beam radiotherapy in young children. Although complications were observed, additional analysis is needed to determine the relative contributions of the disease process and specific components of the multimodality treatment to these adverse events.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA 94115-1708, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Gillis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sutton
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Dewitt
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
authors.forename: Vivian
authors.initials: V
authors.lastname: Weinberg
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Fisch
authors.forename: Albert
authors.initials: A
authors.lastname: Chan
authors.forename: Charles
authors.initials: C
authors.lastname: Gooding
authors.forename: Heike
authors.initials: H
authors.lastname: Daldrup-Link
authors.forename: William M
authors.initials: WM
authors.lastname: Wara
authors.forename: Diana L
authors.initials: DL
authors.lastname: Farmer
authors.forename: Michael R
authors.initials: MR
authors.lastname: Harrison
authors.forename: Daphne
authors.initials: D
authors.lastname: Haas-Kogan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D009364:Neoplasm Recurrence, Local; D009447:Neuroblastoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D016896:Treatment Outcome