Fractionated low‐dose radiotherapy after myeloablative stem cell transplantation for local control in patients with high‐risk neuroblastoma

Cancer - Tập 100 Số 6 - Trang 1268-1275 - 2004
Scott Bradfield1, James G. Douglas2, Douglas S. Hawkins1, Jean E. Sanders3, Julie R. Park1
1Department of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, Seattle, Washington
2Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
3Pediatric Oncology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington

Tóm tắt

AbstractBACKGROUNDThe optimal administration of radiotherapy for patients with high‐risk neuroblastoma (NB) currently is undefined in the context of modern therapy using myeloablative chemotherapy with autologous stem cell rescue (hematopoietic stem cell transplantation [HSCT]).METHODSThe authors conducted a retrospective review of the records of 21 consecutive patients with high‐risk NB to assess local control and toxicity of external beam radiotherapy (XRT). Therapy included multiagent induction chemotherapy and delayed surgical resection, consolidation of HSCT and local XRT, and 13‐cis‐retinoic acid maintenance therapy. XRT was delivered to the primary site, using postchemotherapy volumes, and to initial metastatic sites with 1–2 cm margins to 2100 centigrays (cGy) using 14 fractions administered once daily.RESULTSFour of 21 patients did not receive XRT due to toxic death (n = 2), disease progression before XRT (n = 1), or parental refusal (n = 1). The median time to XRT post‐HSCT was 54 days. Thirteen patients received a second peripheral blood stem cell infusion after completing XRT. Twelve of the 14 patients who received XRT post‐HSCT and for whom toxicity data were available had Grade 3–4 acute toxicities, including gastrointestinal toxicity (n = 8), hematologic toxicity (n = 9), and infection (n = 1). Nonrecurrent long‐term toxicities included prolonged nutritional deficiency (n = 9) and leg‐length discrepancy (n = 1). Tumors recurred in 7 of 21 patients (5 of 17 patients who received radiotherapy), either within a radiation field (n = 1) or at distant nonirradiated sites (n = 6). The estimated local failure rate was 7% (95% confidence interval [95% CI], 0–14%), with a 2‐year event‐free survival rate of 48% (95% CI, 26–70%).CONCLUSIONSPost‐HSCT, fractionated XRT to 2100 cGy was a tolerable and effective treatment for patients with high‐risk NB, and minimal recurrences were observed at designated XRT sites. Cancer 2004. © 2004 American Cancer Society.

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Cancer

Tập 100 Số 6

1268-1275

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