title: The role of chest computed tomography (CT) as a surveillance tool in children with high-risk neuroblastoma.
abstract: BACKGROUND
  Standardization of imaging obtained in children with neuroblastoma is not well established. This study examines chest CT in pediatric patients with high-risk neuroblastoma.
  
  
  METHODS
  Medical records and imaging from 88 patients with high-risk neuroblastoma, diagnosed at St. Jude Children's Research Hospital between January, 2002 and December, 2009, were reviewed. Surveillance imaging was conducted through 2013. Ten patients with thoracic disease at diagnosis were excluded. Event free survival (EFS) and overall survival (OS) were estimated. Size specific dose estimates for CT scans of the chest, abdomen, and pelvis were used to estimate absolute organ doses to 23 organs. Organ dosimetry was used to calculate cohort effective dose.
  
  
  RESULTS
  The 5 year OS and EFS were 51.9% ± 6.5% and 42.6% ± 6.5%, respectively. Forty-six (58.9%) patients progressed/recurred and 41 (52.6%) died of disease. Eleven patients (14%) developed thoracic disease progression/recurrence identified by chest CT (1 paraspinal mass, 1 pulmonary nodules, and 9 nodal). MIBG (metaiodobenzylguanidine) scans identified thoracic disease in six patients. Five of the 11 had normal chest MIBG scans; three were symptomatic and two were asymptomatic with normal chest MIBG scans but avid bone disease. The estimated radiation dose savings from surveillance without CT chest imaging was 42%, 34% when accounting for modern CT acquisition (2011-2013).
  
  
  CONCLUSIONS
  Neuroblastoma progression/recurrence in the chest is rare and often presents with symptoms or is identified using standard non-CT imaging modalities. For patients with non-thoracic high-risk neuroblastoma at diagnosis, omission of surveillance chest CT imaging can save 35-42% of the radiation burden without compromising disease detection.
authors: Departments of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Departments of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors: Sara M
authors: SM
authors: Federico
authors: Samuel L
authors: SL
authors: Brady
authors: Alberto
authors: A
authors: Pappo
authors: Jianrong
authors: J
authors: Wu
authors: Shenghua
authors: S
authors: Mao
authors: Valerie J
authors: VJ
authors: McPherson
authors: Alison
authors: A
authors: Young
authors: Wayne L
authors: WL
authors: Furman
authors: Robert
authors: R
authors: Kaufman
authors: Sue
authors: S
authors: Kaste
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012306:Risk; D014057:Tomography, X-Ray Computed
keywords: ALARA; chest CT; computed tomography; neuroblastoma; radiation exposure
references: J Clin Oncol. 2006 Jun 20;24(18):2891-6
references: 16782928
references: Pediatr Radiol. 2011 Sep;41 Suppl 2:461-6
references: 21847723
references: J Pediatr Hematol Oncol. 1999 May-Jun;21(3):181-9
references: 10363850
references: Radiology. 2012 Dec;265(3):832-40
references: 23093679
references: Eur J Cancer. 2009 Nov;45(16):2835-42
references: 19616426
references: Med Phys. 2014 Jul;41(7):071917
references: 24989395
references: Pediatr Blood Cancer. 2005 Nov;45(6):781-6
references: 15714448
references: J Clin Oncol. 2001 Jul 1;19(13):3163-72
references: 11432882
references: J Natl Cancer Inst. 2009 Aug 19;101(16):1131-40
references: 19648511
references: Med Phys. 2012 Sep;39(9):5520-31
references: 22957619
references: N Engl J Med. 2008 Feb 21;358(8):851; author reply 852-3
references: 18293514
references: Radiology. 2011 Oct;261(1):243-57
references: 21586679
references: Pediatrics. 2007 Sep;120(3):677-82
references: 17766543
references: Radiology. 2014 Jan;270(1):223-31
references: 23901128
references: Curr Opin Pediatr. 2005 Feb;17(1):7-13
references: 15659956
references: J Pediatr Hematol Oncol. 2015 Jan;37(1):e6-e12
references: 24633303
references: Int J Cancer. 2003 Dec 10;107(5):791-6
references: 14566829
references: Cancer. 2008 Jun 15;112(12):2796-801
references: 18429000
references: Med Pediatr Oncol. 2002 Apr;38(4):229-39
references: 11920786
references: AJR Am J Roentgenol. 2001 Mar;176(3):755-9
references: 11222220
references: Pediatr Blood Cancer. 2005 Sep;45(3):324-32
references: 15714447
references: AJR Am J Roentgenol. 2001 Feb;176(2):289-96
references: 11159059
references: Med Phys. 2000 May;27(5):828-37
references: 10841384
references: Int J Radiat Oncol Biol Phys. 2006 Apr 1;64(5):1424-31
references: 16427213
references: Pediatr Blood Cancer. 2013 Aug;60(8):1253-60
references: 23572212
references: Med Phys. 2012 Jul;39(7Part2):4615-4616
references: 28516563
references: J Clin Oncol. 2011 Aug 20;29(24):3286-92
references: 21768459
references: Lancet. 2007 Jun 23;369(9579):2106-20
references: 17586306
references: Med Phys. 2011 Feb;38(2):820-9
references: 21452719
references: Cancer. 2005 Mar 15;103(6):1274-9
references: 15674854
references: Pediatr Radiol. 2009 Nov;39(11):1142-6
references: 19789861
references: N Engl J Med. 2010 Sep 30;363(14):1324-34
references: 20879881
references: Radiology. 2009 Jul;252(1):4-6
references: 19561246
references: Pediatr Radiol. 2011 May;41 Suppl 1:S166-9
references: 21327772