Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Purpose Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proto...

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Bibliographic Details
Published in:Pediatric blood & cancer 2019-08, Vol.66 (8), p.e27786-n/a
Main Authors: Bagley, Alexander F., Grosshans, David R., Philip, Nancy V., Foster, Jennifer, McAleer, Mary Frances, McGovern, Susan L., Lassen‐Ramshad, Yasmin, Mahajan, Anita, Paulino, Arnold C.
Format: Article
Language:English
Subjects:
Child
Child, Preschool
Disease control
Female
Follow-Up Studies
Hematology
Humans
Infant
local control
Male
Metastases
Metastasis
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - radiotherapy
Neoplasm, Residual - pathology
Neoplasm, Residual - radiotherapy
Nephropathy
Neuroblastoma
Neuroblastoma - pathology
Neuroblastoma - radiotherapy
Oncology
Pediatrics
Prospective Studies
proton therapy
Proton Therapy - methods
Radiation
radiotherapy
Relative Biological Effectiveness
Relative biological effectiveness (RBE)
Survival
Toxicity
Treatment Outcome
Tumors
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Summary:Purpose Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. Methods and materials Eighteen patients with high‐risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post‐induction MIBG‐avid metastatic sites. Primary sites (n = 18) were treated to 21–36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21–24 Gy (RBE). Local control and survival rates were calculated using the Kaplan–Meier method. Results With a median follow‐up of 60.2 months, two‐ and five‐year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five‐year progression‐free survival (PFS) was 64%, and the five‐year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation‐related nephropathy or hepatopathy was reported. Conclusions Excellent local control was achieved using proton therapy to the primary and post‐induction MIBG‐positive distant sites. The predominant site of failure is progression in post‐induction non‐MIBG‐avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.
ISSN:1545-5009
1545-5017
DOI:10.1002/pbc.27786