Managing local‐regional failure in children with high‐risk neuroblastoma: A single institution experience

Abstract

Background: Intensification of systemic therapy for high-risk neuroblastoma (HRNB) has resulted in improved local control and overall survival leaving potential for de-escalation of primary site radiotherapy. The utility of primary site de-escalation should be evaluated in the context of potential for successful local-regional salvage. We evaluated salvage strategies and outcomes in HRNB patients with local-regional recurrence as a component of first failure. Methods: Twenty of 89 patients with HRNB experienced local-regional recurrence as a component of first relapse after chemotherapy, radiotherapy, surgery, and stem cell transplant from 1997–2013. We reviewed salvage therapy strategies and disease control, and report on the impact of local therapy as salvage for local-regional relapse. Results: Six of 20 patients with local-regional failure (LRF) were alive after a median follow-up of 13 years (range, 0.9–25.2 years). Median overall survival (OS) was 4.6 years (95% CI, 0.6 – not reached) vs. 0.6 years (95% CI, 0.05–2.6) after LRF with and without distant failure (DF) respectively (p=0.03). Overall survival in patients receiving salvage radiotherapy was comparable to those receiving initial adjuvant but no salvage radiotherapy. Time to first failure and death was significantly impacted by the intensity of frontline systemic therapy (p=0.03). Salvage radiotherapy reduced the hazard for subsequent LRF (HR 0.3, 95% CI 0.1–0.9, p=0.04) but not OS (p=0.07). Conclusions: Our study highlights the potential of local control strategies at first failure in patients with LRF when primary site radiotherapy was initially omitted, and delineates potential selection factors which may further improve the therapeutic ratio.

Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry

“…So far, only a few studies investigated irradiation for local or metastatic recurrence. Dove et al reported on a cohort of 20 HR NB patients treated for loco-regional relapse [ 14 ]. Ten of these twenty patients received RT with a median total dose of 27 Gy.…”

Combining immunotherapy with high-dose radiation therapy (HDRT) significantly inhibits tumor growth in a syngeneic mouse model of high-risk neuroblastoma

“…HDRT delivered as Stereotactic Body Radiation Therapy (SBRT), Stereotactic Radiosurgery (SRS) or Intraoperative Radiation Therapy (IORT) is increasingly being used in pediatric cancers [ [7] , [8] , [9] ]. HDRT improves the outcome for several high-risk neuroblastoma patients [ 10 , 11 ]. Given these advances there is great interest in immunotherapy in neuroblastoma, used alone or in combination with HDRT, to improve patient outcome.…”