Radiation therapy to the primary and postinduction chemotherapy MIBG-avid sites in high-risk neuroblastoma

Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):858-62. doi: 10.1016/j.ijrobp.2014.07.019. Epub 2014 Sep 20.

Abstract

Purpose: Although it is generally accepted that consolidation therapy for neuroblastoma includes irradiation of the primary site and any remaining metaiodobenzylguanidine (MIBG)-avid metastatic sites, limited information has been published regarding the efficacy of this approach.

Methods and materials: Thirty patients with high-risk neuroblastoma were treated at 1 radiation therapy (RT) department after receiving 5 cycles of induction chemotherapy and resection. All patients had at least a partial response after induction therapy, based upon international neuroblastoma response criteria. The primary sites were treated with 24 to 30 Gy whereas the MIBG-avid metastatic sites were treated with 24 Gy. RT was followed by high-dose chemotherapy with autologous stem cell rescue and 6 months of cis-retinoic acid.

Results: The 5-year progression-free survival (PFS) and overall survival (OS) rates were 48% and 59%, respectively. The 5-year locoregional control at the primary site was 84%. There were no differences in locoregional control according to degree of primary surgical resection. The 5-year local control rate for metastatic sites was 74%. The 5-year PFS rates for patients with 0, 1, 2, and >3 postinduction MIBG sites were 66%, 57%, 20%, and 0% (P<.0001), respectively, whereas 5-year OS rates were 80%, 57%, 50%, and 0%, respectively (P<.0001).

Conclusions: RT to the primary site and postinduction MIBG-positive metastatic sites was associated with 84% and 74% local control, respectively. The number of MIBG-avid sites present after induction chemotherapy and surgery was predictive of progression-free and overall survival.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Iodobenzylguanidine / pharmacokinetics
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carboplatin / administration & dosage
  • Child
  • Child, Preschool
  • Cisplatin / administration & dosage
  • Consolidation Chemotherapy / methods
  • Cyclophosphamide / administration & dosage
  • Disease-Free Survival
  • Dose Fractionation, Radiation
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Induction Chemotherapy / methods
  • Infant
  • Neoplasm, Residual
  • Neuroblastoma / diagnostic imaging*
  • Neuroblastoma / metabolism
  • Neuroblastoma / mortality
  • Neuroblastoma / radiotherapy*
  • Neuroblastoma / therapy
  • Radionuclide Imaging
  • Radiopharmaceuticals / pharmacokinetics
  • Retrospective Studies
  • Survival Rate
  • Young Adult

Substances

  • Radiopharmaceuticals
  • 3-Iodobenzylguanidine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Carboplatin
  • Cisplatin