title: Long-term side effects of radiotherapy for pediatric localized neuroblastoma : results from clinical trials NB90 and NB94.
abstract: BACKGROUND
  Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94.
  
  
  METHODS
  From 1990-2000, 610 children were enrolled. Among these, 35 were treated with induction chemotherapy, surgery, and RT. The recommended RT dose was 24 Gy at ≤ 2 years, 34 Gy at > 2 years, ± a 5 Gy boost in both age groups.
  
  
  RESULTS
  The 22 patients still alive after 5 years were analyzed. The median follow-up time was 14 years (range 5-21 years). Late effects after therapy occurred in 73 % of patients (16/22), within the RT field for 50 % (11/22). The most frequent in-field effects were musculoskeletal abnormalities (n = 7) that occurred only with doses > 31 Gy/1.5 Gy fraction (p = 0.037). Other effects were endocrine in 3 patients and second malignancies in 2 patients. Four patients presented with multiple in-field late effects only with doses > 31 Gy.
  
  
  CONCLUSIONS
  After a median follow-up of 14 years, late effects with multimodality treatment were frequent. The most frequent effects were musculoskeletal abnormalities and the threshold for their occurrence was 31 Gy.
authors.affiliation: Département de radiothérapie, Institut Claudius Regaud, 31059, Toulouse, France, ducassou.anne@iuct-oncopole.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Ducassou
authors.forename: Marion
authors.initials: M
authors.lastname: Gambart
authors.forename: Caroline
authors.initials: C
authors.lastname: Munzer
authors.forename: Laetitia
authors.initials: L
authors.lastname: Padovani
authors.forename: Christian
authors.initials: C
authors.lastname: Carrie
authors.forename: Daphne
authors.initials: D
authors.lastname: Haas-Kogan
authors.forename: Valérie
authors.initials: V
authors.lastname: Bernier-Chastagner
authors.forename: Charlotte
authors.initials: C
authors.lastname: Demoor
authors.forename: Line
authors.initials: L
authors.lastname: Claude
authors.forename: Sylvie
authors.initials: S
authors.lastname: Helfre
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Bolle
authors.forename: Julie
authors.initials: J
authors.lastname: Leseur
authors.forename: Aymeri
authors.initials: A
authors.lastname: Huchet
authors.forename: Hervé
authors.initials: H
authors.lastname: Rubie
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schleiermacher
authors.forename: Carole
authors.initials: C
authors.lastname: Coze
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Defachelles
authors.forename: Aurélien
authors.initials: A
authors.lastname: Marabelle
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ducassou
authors.forename: Christine
authors.initials: C
authors.lastname: Devalck
authors.forename: Virginie
authors.initials: V
authors.lastname: Gandemer
authors.forename: Martine
authors.initials: M
authors.lastname: Munzer
authors.forename: Anne
authors.initials: A
authors.lastname: Laprie
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005260:Female; D005602:France; D005784:Gene Amplification; D006801:Humans; D007223:Infant; D008297:Male; D000071447:N-Myc Proto-Oncogene Protein; D018365:Neoplasm, Residual / Q000401:mortality / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D009447:Neuroblastoma / Q000235:genetics / Q000401:mortality / Q000532:radiotherapy*; D009687:Nuclear Proteins / Q000235:genetics; D015513:Oncogene Proteins / Q000235:genetics; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis
chemical_list: C459801:MYCN protein, human; D000071447:N-Myc Proto-Oncogene Protein; D009687:Nuclear Proteins; D015513:Oncogene Proteins