title: Outcomes After Radiation Therapy to Metastatic Sites in Patients With Stage 4 Neuroblastoma.
abstract: In patients with high-risk metastatic neuroblastoma, the benefit of radiation therapy (RT) to metastatic sites as part of primary treatment has not been fully investigated. The purpose of this single-institution study was to evaluate local control of irradiated metastatic sites, and characterize metastatic disease burden and anatomic distribution in patients with high-risk metastatic neuroblastoma. The records of all patients diagnosed with stage 4 neuroblastoma between August 2000 and January 2010 were reviewed. Exclusion criteria included: bone-marrow only metastatic site, total body irradiation, or no imaging follow-up. A total of 37 patients met eligibility criteria. Median follow-up period for patients without relapse was 61 months. Five-year overall survival for all patients was 67%. Thirteen patients (35%) received RT to a metastatic site as part of their primary treatment. Among these patients, in-field recurrence occurred in three patients (23%), including two of three treated calvarial sites. In patients treated with or without RT to a metastatic site, respectively, there was no significant difference in 5-year overall survival (73% vs. 63%, P=0.84) or relapse-free survival (46% and 55%, P=0.48). Current metastatic site RT dose may be suboptimal, and certain locations may predict for a poor response. Further studies are necessary to elucidate the optimal role of RT to metastatic sites.
authors.affiliation: *Department of Radiation Oncology, Emory University and Winship Cancer Institute ‡Department of Biostatistics and Bioinformatics, Emory University §Aflac Cancer Center and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA †Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, NC.
authors.forename: Shravan
authors.initials: S
authors.lastname: Kandula
authors.forename: Roshan S
authors.initials: RS
authors.lastname: Prabhu
authors.forename: Ronica
authors.initials: R
authors.lastname: Nanda
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Switchenko
authors.forename: Thomas
authors.initials: T
authors.lastname: Cash
authors.forename: Muna
authors.initials: M
authors.lastname: Qayed
authors.forename: Howard
authors.initials: H
authors.lastname: Katzenstein
authors.forename: Natia
authors.initials: N
authors.lastname: Esiashvili
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D015996:Survival Rate; D055815:Young Adult