Original article
Radiation therapy as part of local control of metastatic neuroblastoma: the St Jude Children's Research Hospital experience,☆☆

https://doi.org/10.1016/j.jpedsurg.2009.11.003Get rights and content

Abstract

Purpose

The purpose of the study was to compare outcomes of pediatric patients with high-risk metastatic neuroblastoma who received radiotherapy (RT) with those of patients who did not.

Patients and methods

We reviewed the records of 63 patients with newly diagnosed metastatic neuroblastoma treated at our institution (1989-2001) to investigate their characteristics at presentation, dose and field of RT, treatment response, and failure patterns.

Results

Seventeen patients received RT, and 46 did not. In the RT group, a greater percentage of patients had residual disease before consolidation than did those in the no-RT group (88.2% vs 69.6%, P = .008). Gross total resection was achieved less often in the RT group (65% vs 89%, P = .055), but the 5-year cumulative incidences of local failure were similar (35.3% ± 12.4% vs 32.6% ± 7.1%). Although there was no difference in 5-year event-free survival, overall survival was better in the no-RT group (47.8% ± 7.2% vs 23.5% ± 9.2%, P = .026).

Conclusion

The addition of RT to the therapy of a group of patients with more residual locoregional disease appeared to improve the local failure rate to approximately that of patients with less residual disease. Radiotherapy may provide even greater benefit to those with less residual disease before consolidation.

Section snippets

Patients

This retrospective study was approved by the Institutional Review Board of St Jude Children's Research Hospital, which also approved all institutional treatment protocols. We reviewed the records of 75 children older than 1 year at the time of diagnosis of International Neuroblastoma Staging System stage 4 neuroblastoma who were treated on 1 of 3 consecutive institutional protocols at St Jude between June 1989 and February 2001. Twelve patients were excluded from the analysis: 1 patient with an

Patient characteristics

The characteristics of the 63 pediatric patients included in this study are shown in Table 1. The median age at the time of diagnosis was 3.09 years (range, 1.16-16.84 years). At the time of analysis, 18 patients were alive with a median follow-up of 10.7 years (range, 5.3-17.5 years). Fourteen survivors had undergone follow-up within the last year.

Radiation therapy

As part of their initial therapy, 17 patients received external-beam RT (EBRT) to their primary tumor sites as detailed in Table 2. These sites

Discussion

In this retrospective study of outcome in pediatric patients with high-risk metastatic neuroblastoma treated on 1 of 3 St Jude protocols, we found that patients who received RT did not experience improved local disease control. To interpret these results, we considered the characteristics of these nonrandomly selected groups. Patients in the RT group were less likely to have undergone GTR and were more likely to have residual disease at the end of induction chemotherapy. Intuitively, this group

Acknowledgments

This work was supported by Childhood Cancer Solid Tumor Program Project Grant CA-23099 and Cancer Center Support Grant CA-21765 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities. Neither of these funding sources were involved in the design, conduct, or reporting of this study. We thank Angela McArthur and Brenda Clark for assistance with manuscript preparation.

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  • Cited by (0)

    These results were presented in part at the 59th Annual Meeting of the Section of Surgery, American Academy of Pediatrics National Conference and Exhibition, San Francisco, CA, October 25-27, 2007.

    ☆☆

    None of the authors have any financial or personal relationships that would affect or be affected by the results of this study.

    1

    Current address: Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226.

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