1. Implications of Image-Defined Risk Factors and Primary-Site Response on Local Control and Radiation Treatment Delivery in the Management of High-Risk Neuroblastoma: Is There a Role for De-escalation of Adjuvant Primary-Site Radiation Therapy?
- Author
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Matthew J. Krasin, Yimei Li, Daniel V. Wakefield, Teresa Santiago, Victor M. Santana, John T. Lucas, M. Beth McCarville, David A. Cooper, Andrew M. Davidoff, Mikhail Doubrovin, Wayne L. Furman, and Xingyu Li
- Subjects
Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Tumor resection ,Disease-Free Survival ,Article ,030218 nuclear medicine & medical imaging ,Neuroblastoma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,High risk neuroblastoma ,Radiation treatment delivery ,Child ,Retrospective Studies ,Radiation ,business.industry ,Distant relapse ,Infant ,Radiotherapy Dosage ,medicine.disease ,Magnetic Resonance Imaging ,Survival Analysis ,Radiation therapy ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,Tomography, X-Ray Computed ,business ,Adjuvant ,De-escalation - Abstract
The predictive value of Image-Defined Risk Factors (IDRFs) developed by the International Neuroblastoma Risk Group Task Force as it relates to primary-site management is undefined and may aid patient selection for de-escalation of adjuvant radiation therapy to the primary site in high-risk neuroblastoma.Patients (N = 76) with high-risk neuroblastoma treated on prospective trials at our institution from 1997 to 2014 were eligible for inclusion. IDRFs were defined based on pretherapy imaging. Overall survival, progression-free survival, and locoregional failure-free survival (LRFFS) were described using the Kaplan-Meier estimator and tested across strata by using the log-rank test.Twenty of 76 patients (26%) experienced local (n = 6), regional (n = 6), or combined locoregional failure (n = 8) with or without distant failure. Ten (50%) of the locoregional failures had concurrent distant relapse. Of patients who completed all therapy, both those with no IDRFs and those with90% resection had a 3-year LRFFS of 100%, with or without radiation therapy. Patients with either ≥1 IDRF or Gross Total Resection (GTR) or the inability to complete all therapy had inferior 3-year LRFFS of 77.8% and 14.4% with or without radiation therapy, respectively (P .04). Patients treated with a dose ≥30.6 Gy as part of therapy for residual disease had an 83.3% locoregional control rate.Patients with90% tumor resection and no primary site IDRFs at diagnosis may be candidates for de-escalation of adjuvant primary-site radiation therapy, although validation of these findings in future studies is required.
- Published
- 2019