Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neurob
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ORIGINAL ARTICLE
Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004 Danny Jazmati1 · Sarina Butzer2 · Barbara Hero2 · Jerome Doyen1 · Dalia Ahmad Khalil1 · Theresa Steinmeier1 · Stefanie Schulze Schleithoff1 · Angelika Eggert3 · Thorsten Simon2 · Beate Timmermann4 Received: 10 July 2020 / Accepted: 16 November 2020 © The Author(s) 2020
Abstract Purpose Neuroblastoma (NB) is the most common extracranial solid malignancy during childhood. Despite a multimodal treatment approach, the prognosis of patients with metastatic NB is not satisfactory. Although radiotherapy (RT) has become an integral part of treatment of the primary tumor, the role of RT in osteomedullary lesions is not well defined. A retrospective analysis was conducted to evaluate the impact of RT for metastatic sites in children with high-risk NB. Methods All patients with stage 4 NB from the prospective, multicenter NB trials NB97 and NB2004 who received RT to metastatic sites during frontline treatment were included in this retrospective analysis. Results A total of 18 children were irradiated with a median dose of 36 Gray (Gy; range 20–45 Gy) to one or more (range 1–3) osteomedullary metastases with or without concomitant RT to the primary tumor site. The median follow-up time was 149 months (range 55–220) in survivors. At 5 years, local relapse-free survival (LRFS) at irradiated metastatic sites and metastases-free survival (MFS) at distant, non-irradiated site rates were 51.4 and 39.9%, respectively. The estimated overall survival (OS) rate at 5 years was 49.4%. No high-grade acute or late toxicity and no secondary malignancy was reported. Conclusion RT to metastases is feasible for patients with stage 4 NB. However, an impact of RT to residual metastatic sites on outcome was not found. Studies with larger cohorts or prospective trials would be desirable in order to elucidate the role of RT for metastases.
Keywords Childhood cancer · Survival · Clinical trial · Radiation oncology · Stage 4
Introduction Dr. med. Danny Jazmati
[email protected] 1
Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
2
Children’s Hospital, University of Cologne, Cologne, Germany
3
Department of Pediatrics, Division of Oncology and Hematology, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
4
Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
Deriving from the developing sympathetic nervous system, neuroblastoma (NB) is the most common extracranial solid tumor in children, accounting for 7–10% of all pediatric malignancies [1]. Patients are classified and tre
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