title: Radiation therapy to the primary and postinduction chemotherapy MIBG-avid sites in high-risk neuroblastoma.
abstract: OBJECTIVE
  Although it is generally accepted that consolidation therapy for neuroblastoma includes irradiation of the primary site and any remaining metaiodobenzylguanidine (MIBG)-avid metastatic sites, limited information has been published regarding the efficacy of this approach.
  
  
  METHODS
  Thirty patients with high-risk neuroblastoma were treated at 1 radiation therapy (RT) department after receiving 5 cycles of induction chemotherapy and resection. All patients had at least a partial response after induction therapy, based upon international neuroblastoma response criteria. The primary sites were treated with 24 to 30 Gy whereas the MIBG-avid metastatic sites were treated with 24 Gy. RT was followed by high-dose chemotherapy with autologous stem cell rescue and 6 months of cis-retinoic acid.
  
  
  RESULTS
  The 5-year progression-free survival (PFS) and overall survival (OS) rates were 48% and 59%, respectively. The 5-year locoregional control at the primary site was 84%. There were no differences in locoregional control according to degree of primary surgical resection. The 5-year local control rate for metastatic sites was 74%. The 5-year PFS rates for patients with 0, 1, 2, and >3 postinduction MIBG sites were 66%, 57%, 20%, and 0% (P<.0001), respectively, whereas 5-year OS rates were 80%, 57%, 50%, and 0%, respectively (P<.0001).
  
  
  CONCLUSIONS
  RT to the primary site and postinduction MIBG-positive metastatic sites was associated with 84% and 74% local control, respectively. The number of MIBG-avid sites present after induction chemotherapy and surgery was predictive of progression-free and overall survival.
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Mazloom
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Chrystal U
authors.initials: CU
authors.lastname: Louis
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Jed
authors.initials: J
authors.lastname: Nuchtern
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kim
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Heidi
authors.initials: H
authors.lastname: Russell
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Wendy
authors.initials: W
authors.lastname: Allen-Rhoades
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Krance
authors.affiliation: Houston Methodist Hospital, Texas Children's Hospital, and Baylor College of Medicine, Houston, Texas. Electronic address: apaulino@mdanderson.org.
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D019797:3-Iodobenzylguanidine / Q000493:pharmacokinetics; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D060830:Consolidation Chemotherapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D007223:Infant; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin