Danny Jazmati1, Sarina Butzer2, Barbara Hero2, Dalia Ahmad Khalil1, Julien Merta1, Christian Bäumer1,3,4, Gina Plum2, Jörg Fuchs5, Friederike Koerber6, Theresa Steinmeier1, Sarah Peters1, Jerome Doyen1, Theresa Thole7, Matthias Schmidt8, Christoph Blase9, Stephan Tippelt10, Angelika Eggert7, Rudolf Schwarz11, Thorsten Simon2, Beate Timmermann1,4. 1. Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany. 2. Children's Hospital, University of Cologne, Cologne, Germany. 3. Faculty of Physics, TU Dortmund University, Dortmund, Germany. 4. Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany. 5. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Tübingen, Germany. 6. Department of Radiology, University of Cologne, Cologne, Germany. 7. Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany. 8. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany. 9. Anästhesienetz Rhein Ruhr, Bochum, Germany. 10. University Hospital of Essen, Paediatrics III, Paediatric Haematology and Oncology, Essen, Germany. 11. Department of Radiotherapy and Radiooncology, Outpatient Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
OBJECTIVE: Radiotherapy (RT) is an integral part of the interdisciplinary treatment of patients with high-risk neuroblastoma (NB). With the continuous improvements of outcome, the interest in local treatment strategies that reduce treatment-related side effects while achieving optimal oncological results is growing. Proton beam therapy (PBT) represents a promising alternative to conventional photon irradiation with regard to the reduction of treatment burden. METHOD: Retrospective analysis of children with high or intermediate risk NB receiving PBT of the primary tumor site during first-line therapy between 2015 and 2020 was performed. Data from the prospective in-house registry Standard Protonentherapie WPE - Kinder- (KiProReg) with respect to tumor control and treatment toxicity were analyzed. Adverse events were classified according to CTCAE Version 4 (V4.0) before, during, and after PBT. RESULTS: In total, 44 patients (24 male, 20 female) with high (n = 39) or intermediate risk NB (n = 5) were included in the analysis. Median age was 3.4 years (range, 1.4-9.9 years). PBT doses ranged from 21.0 to 39.6 Gray (Gy) (median 36.0 Gy). Five patients received PBT to the MIBG-avid residual at the primary tumor site at time of PBT according to the NB-2004 protocol. In 39 patients radiation was given to the pre-operative tumor bed with or without an additional boost in case of residual tumor. After a median follow-up (FU) of 27.6 months, eight patients developed progression, either local recurrence (n = 1) or distant metastases (n = 7). Four patients died due to tumor progression. At three years, the estimated local control, distant metastatic free survival, progression free survival, and overall survival was 97.7, 84.1, 81.8, and 90.9%, respectively. During radiation, seven patients experienced higher-grade (CTCAE ≥ °3) hematologic toxicity. No other higher grade acute toxicity occurred. After PBT, one patient developed transient myelitis while receiving immunotherapy. No higher grade long-term toxicity was observed up to date. CONCLUSION: PBT was a well tolerated and effective local treatment in children with high and intermediate risk NB. The role of RT in an intensive multidisciplinary treatment regimen remains to be studied in the future in order to better define timing, doses, target volumes, and general need for RT in a particularly sensitive cohort of patients.
OBJECTIVE: Radiotherapy (RT) is an integral part of the interdisciplinary treatment of patients with high-risk neuroblastoma (NB). With the continuous improvements of outcome, the interest in local treatment strategies that reduce treatment-related side effects while achieving optimal oncological results is growing. Proton beam therapy (PBT) represents a promising alternative to conventional photon irradiation with regard to the reduction of treatment burden. METHOD: Retrospective analysis of children with high or intermediate risk NB receiving PBT of the primary tumor site during first-line therapy between 2015 and 2020 was performed. Data from the prospective in-house registry Standard Protonentherapie WPE - Kinder- (KiProReg) with respect to tumor control and treatment toxicity were analyzed. Adverse events were classified according to CTCAE Version 4 (V4.0) before, during, and after PBT. RESULTS: In total, 44 patients (24 male, 20 female) with high (n = 39) or intermediate risk NB (n = 5) were included in the analysis. Median age was 3.4 years (range, 1.4-9.9 years). PBT doses ranged from 21.0 to 39.6 Gray (Gy) (median 36.0 Gy). Five patients received PBT to the MIBG-avid residual at the primary tumor site at time of PBT according to the NB-2004 protocol. In 39 patients radiation was given to the pre-operative tumor bed with or without an additional boost in case of residual tumor. After a median follow-up (FU) of 27.6 months, eight patients developed progression, either local recurrence (n = 1) or distant metastases (n = 7). Four patients died due to tumor progression. At three years, the estimated local control, distant metastatic free survival, progression free survival, and overall survival was 97.7, 84.1, 81.8, and 90.9%, respectively. During radiation, seven patients experienced higher-grade (CTCAE ≥ °3) hematologic toxicity. No other higher grade acute toxicity occurred. After PBT, one patient developed transient myelitis while receiving immunotherapy. No higher grade long-term toxicity was observed up to date. CONCLUSION: PBT was a well tolerated and effective local treatment in children with high and intermediate risk NB. The role of RT in an intensive multidisciplinary treatment regimen remains to be studied in the future in order to better define timing, doses, target volumes, and general need for RT in a particularly sensitive cohort of patients.
Authors: Atmaram S Pai Panandiker; Chris Beltran; Catherine A Billups; Lisa M McGregor; Wayne L Furman; Andrew M Davidoff Journal: Pediatr Blood Cancer Date: 2012-09-28 Impact factor: 3.167
Authors: Dana L Casey; Ken L Pitter; Brian H Kushner; Nai-Kong V Cheung; Shakeel Modak; Michael P LaQuaglia; Suzanne L Wolden Journal: Int J Radiat Oncol Biol Phys Date: 2018-01-09 Impact factor: 7.038
Authors: Dana L Casey; Brian H Kushner; Nai-Kong V Cheung; Shakeel Modak; Michael P LaQuaglia; Suzanne L Wolden Journal: Pediatr Blood Cancer Date: 2018-02-22 Impact factor: 3.167
Authors: Christine Hill-Kayser; Zelig Tochner; Stefan Both; Robert Lustig; Anne Reilly; Naomi Balamuth; Richard Womer; John Maris; Stephen Grupp; Rochelle Bagatell Journal: Pediatr Blood Cancer Date: 2013-06-04 Impact factor: 3.167
Authors: Marjolein van Waas; Sebastian J C M M Neggers; Hein Raat; Caroline M van Rij; Rob Pieters; Marry M van den Heuvel-Eibrink Journal: PLoS One Date: 2012-12-14 Impact factor: 3.240