Richard Li1, Alexei Polishchuk2, Steven DuBois3, Randall Hawkins2, Stephanie W Lee4, Rochelle Bagatell5, Suzanne Shusterman3, Christine Hill-Kayser6, Hasan Al-Sayegh7, Lisa Diller3, Daphne A Haas-Kogan8, Katherine K Matthay2, Wendy B London3, Karen J Marcus9. 1. Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts. 2. School of Medicine, University of California San Francisco, San Francisco, California. 3. Harvard Medical School, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. 4. Brigham and Women's Hospital, Boston, Massachusetts. 5. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. 8. Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. 9. Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. Electronic address: kmarcus@lroc.harvard.edu.
Abstract
PURPOSE: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. METHODS AND MATERIALS: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. RESULTS: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). CONCLUSIONS: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.
PURPOSE: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. METHODS AND MATERIALS: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. RESULTS: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). CONCLUSIONS:Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.
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