title: Locoregional tumor progression after radiation therapy influences overall survival in pediatric patients with neuroblastoma.
abstract: OBJECTIVE
  There is renewed attention to primary site irradiation and local control for patients with high-risk neuroblastoma (NB). We conducted a retrospective review to identify factors that might predict for locoregional tumor control and its impact on overall survival.
  
  
  METHODS
  Between July 2000 through August 2006, a total of 44 pediatric patients with NB received radiation therapy (RT) with curative intent using computed tomography (CT)-based treatment planning. The median age was 3.4 years and the median cumulative dose was 23.4 Gy. Overall survival and locoregional tumor control were measured from the start of RT to the date of death or event as determined by CT/magnetic resonance imaging/meta-iodobenzylguanidine. The influence of age at irradiation, gender, race, cumulative radiation dose, International Neuroblastoma Staging System stage, treatment protocol and resection status was determined with respect to locoregional tumor control.
  
  
  RESULTS
  With a median follow-up of 34 months +/- 21 months, locoregional tumor progression was observed in 11 (25%) and was evenly divided between primary site and adjacent nodal/visceral site failure. The influence of locoregional control reached borderline statistical significance (p = 0.06). Age (p = 0.5), dose (p = 0.6), resection status (p = 0.7), and International Neuroblastoma Staging System stage (p = 0.08) did not influence overall survival.
  
  
  CONCLUSIONS
  Overall survival in high-risk neuroblastoma is influenced by locoregional tumor control. Despite CT-based planning, progression in adjacent nodal/visceral sites appears to be common; this requires further investigation regarding target volume definitions, dose, and the effects of systemic therapy.
authors.affiliation: Division of Radiation Oncology, Department of Radiological Sciences, St. Jude Children's Research Hospital, MS220, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA. Atmaram.Pai-Panandiker@STJUDE.ORG
authors.forename: Atmaram S
authors.initials: AS
authors.lastname: Pai Panandiker
authors.forename: Lisa
authors.initials: L
authors.lastname: McGregor
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: Shengjie
authors.initials: S
authors.lastname: Wu
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009447:Neuroblastoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D049268:Positron-Emission Tomography / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
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