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 Radiotherapy?

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 Radiotherapy?

Int J Radiat Oncol Biol Phys. 2018 Nov 26;:

Authors: Lucas JT, McCarville MB, Cooper DA, Doubrovin M, Wakefield D, Santiago T, Li Y, Li X, Krasin M, Santana V, Furman W, Davidoff AM

Abstract
BACKGROUND: The predictive value of Image-Defined Risk Factors (IDRFs) developed by the International Neuroblastoma Risk Group (INRG) Task Force as it relates to primary site management is undefined and may aid patient selection for de-escalation of adjuvant radiotherapy to the primary site in high risk neuroblastoma (HRNB).
METHODS: Patients (N=76) with HRNB treated on prospective trials at our institution from 1997 to 2014 were eligible for inclusion. IDRFs were defined based on pre-therapy 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.
RESULTS: Twenty (26%) of 76 patients experienced local (N=6), regional (N=6) or combined local-regional failure (N=8) with or without distant failure. Ten (50%) of the locoregional failures had concurrent distant relapse. Patients with no IDRFs, and >90% resection, who completed all therapy had 3 year LRFFS of 100% and 100% with or without radiotherapy, respectively. Patients with either ≥1 IDRFs, <GTR or the inability to complete all therapy had inferior 3 yr LRFFS of 77.8% and 14.4% with or without radiotherapy, respectively (P<0.04). Patients treated with a dose ≥30.6 Gy as part of therapy for residual disease had an 83.3% locoregional control rate.
CONCLUSIONS: Patients with >90% tumor resection and no primary site IDRFs at diagnosis may be candidates for de-escalation of adjuvant primary site radiotherapy although validation of these findings in future studies is required.

PMID: 30496881 [PubMed - as supplied by publisher]

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