title: Patterns of Relapse in High-Risk Neuroblastoma Patients Treated With and Without Total Body Irradiation.
abstract: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated.
  
  
  
  We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI.
  
  
  
  Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03).
  
  
  
  Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Li
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Alexei
authors.initials: A
authors.lastname: Polishchuk
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Steven
authors.initials: S
authors.lastname: DuBois
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Randall
authors.initials: R
authors.lastname: Hawkins
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Bagatell
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Shusterman
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christine
authors.initials: C
authors.lastname: Hill-Kayser
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Hasan
authors.initials: H
authors.lastname: Al-Sayegh
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Daphne A
authors.initials: DA
authors.lastname: Haas-Kogan
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. Electronic address: kmarcus@lroc.harvard.edu.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
mesh_terms: D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary* / Q000628:therapy; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012306:Risk; D018709:Statistics, Nonparametric; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation / Q000706:statistics & numerical data
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine