Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma

Atmaram S. Pai Panandiker, Chris Beltran, Catherine A. Billups, Lisa M. Mcgregor, Wayne L. Furman, Andrew M. Davidoff

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Locoregional failure is a significant concern in patients with high-risk abdominal neuroblastoma (NB) receiving radiotherapy. Locoregional control outcomes were studied in children with NB receiving intensity modulated radiotherapy (IMRT). Procedure: Twenty children (11 females, 9 males) with NB (median age at diagnosis 3.4 years) receiving IMRT were analyzed for locoregional failure, outcomes, and toxicities. IMRT doses were 23.4Gy (n=12), 30Gy (n=1), 30.6Gy (n=5), and 36.0Gy (n=2) based on extent of resection. Five patients had tumors with MYCN amplification, and 19 had metastatic disease. All patients were treated consistently using reproducible immobilization techniques; physiological motion was assessed by 4D-CT, and target localization by cone-beam computed tomography. ICRU 62 volumetric conventions were employed based on institutional data for pediatric target volume and organ motion. Results: No patient developed primary site infield or locoregional failure at a median follow-up of 2.2 years. Distant failure (median time to distant failure 1.6 years) occurred in the brain, lungs, or skeletal sites in eight patients, five of whom died. The 2-year event-free survival was 58.5±13.3% and cumulative incidence of local and distant failures was 0% and 41.5±11.9%, respectively. Asymptomatic loose stool during RT occurred in nearly all patients, but required no intervention. Conclusions: IMRT is feasible, safe in the short term, and yields excellent locoregional control. Despite subtotal resection in some cases, locoregional control appeared to be increased by conformal radiotherapy with ICRU 62-compliant volumes. Dose escalation beyond 30.6Gy may be unnecessary with improved target volume coverage.

Original languageEnglish (US)
Pages (from-to)761-765
Number of pages5
JournalPediatric Blood and Cancer
Volume60
Issue number5
DOIs
StatePublished - May 1 2013

Fingerprint

Neuroblastoma
Intensity-Modulated Radiotherapy
Radiotherapy
Four-Dimensional Computed Tomography
Conformal Radiotherapy
Cone-Beam Computed Tomography
Organ Size
Immobilization
Disease-Free Survival
Pediatrics
Lung
Incidence
Brain
Neoplasms

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Pai Panandiker, Atmaram S. ; Beltran, Chris ; Billups, Catherine A. ; Mcgregor, Lisa M. ; Furman, Wayne L. ; Davidoff, Andrew M. / Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 5. pp. 761-765.
@article{ffd4f455927b438ca00f32c3e51c19c4,
title = "Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma",
abstract = "Background: Locoregional failure is a significant concern in patients with high-risk abdominal neuroblastoma (NB) receiving radiotherapy. Locoregional control outcomes were studied in children with NB receiving intensity modulated radiotherapy (IMRT). Procedure: Twenty children (11 females, 9 males) with NB (median age at diagnosis 3.4 years) receiving IMRT were analyzed for locoregional failure, outcomes, and toxicities. IMRT doses were 23.4Gy (n=12), 30Gy (n=1), 30.6Gy (n=5), and 36.0Gy (n=2) based on extent of resection. Five patients had tumors with MYCN amplification, and 19 had metastatic disease. All patients were treated consistently using reproducible immobilization techniques; physiological motion was assessed by 4D-CT, and target localization by cone-beam computed tomography. ICRU 62 volumetric conventions were employed based on institutional data for pediatric target volume and organ motion. Results: No patient developed primary site infield or locoregional failure at a median follow-up of 2.2 years. Distant failure (median time to distant failure 1.6 years) occurred in the brain, lungs, or skeletal sites in eight patients, five of whom died. The 2-year event-free survival was 58.5±13.3{\%} and cumulative incidence of local and distant failures was 0{\%} and 41.5±11.9{\%}, respectively. Asymptomatic loose stool during RT occurred in nearly all patients, but required no intervention. Conclusions: IMRT is feasible, safe in the short term, and yields excellent locoregional control. Despite subtotal resection in some cases, locoregional control appeared to be increased by conformal radiotherapy with ICRU 62-compliant volumes. Dose escalation beyond 30.6Gy may be unnecessary with improved target volume coverage.",
author = "{Pai Panandiker}, {Atmaram S.} and Chris Beltran and Billups, {Catherine A.} and Mcgregor, {Lisa M.} and Furman, {Wayne L.} and Davidoff, {Andrew M.}",
year = "2013",
month = "5",
day = "1",
doi = "10.1002/pbc.24350",
language = "English (US)",
volume = "60",
pages = "761--765",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "Wiley-Liss Inc.",
number = "5",

}

Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma. / Pai Panandiker, Atmaram S.; Beltran, Chris; Billups, Catherine A.; Mcgregor, Lisa M.; Furman, Wayne L.; Davidoff, Andrew M.

In: Pediatric Blood and Cancer, Vol. 60, No. 5, 01.05.2013, p. 761-765.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intensity modulated radiation therapy provides excellent local control in high-risk abdominal neuroblastoma

AU - Pai Panandiker, Atmaram S.

AU - Beltran, Chris

AU - Billups, Catherine A.

AU - Mcgregor, Lisa M.

AU - Furman, Wayne L.

AU - Davidoff, Andrew M.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Background: Locoregional failure is a significant concern in patients with high-risk abdominal neuroblastoma (NB) receiving radiotherapy. Locoregional control outcomes were studied in children with NB receiving intensity modulated radiotherapy (IMRT). Procedure: Twenty children (11 females, 9 males) with NB (median age at diagnosis 3.4 years) receiving IMRT were analyzed for locoregional failure, outcomes, and toxicities. IMRT doses were 23.4Gy (n=12), 30Gy (n=1), 30.6Gy (n=5), and 36.0Gy (n=2) based on extent of resection. Five patients had tumors with MYCN amplification, and 19 had metastatic disease. All patients were treated consistently using reproducible immobilization techniques; physiological motion was assessed by 4D-CT, and target localization by cone-beam computed tomography. ICRU 62 volumetric conventions were employed based on institutional data for pediatric target volume and organ motion. Results: No patient developed primary site infield or locoregional failure at a median follow-up of 2.2 years. Distant failure (median time to distant failure 1.6 years) occurred in the brain, lungs, or skeletal sites in eight patients, five of whom died. The 2-year event-free survival was 58.5±13.3% and cumulative incidence of local and distant failures was 0% and 41.5±11.9%, respectively. Asymptomatic loose stool during RT occurred in nearly all patients, but required no intervention. Conclusions: IMRT is feasible, safe in the short term, and yields excellent locoregional control. Despite subtotal resection in some cases, locoregional control appeared to be increased by conformal radiotherapy with ICRU 62-compliant volumes. Dose escalation beyond 30.6Gy may be unnecessary with improved target volume coverage.

AB - Background: Locoregional failure is a significant concern in patients with high-risk abdominal neuroblastoma (NB) receiving radiotherapy. Locoregional control outcomes were studied in children with NB receiving intensity modulated radiotherapy (IMRT). Procedure: Twenty children (11 females, 9 males) with NB (median age at diagnosis 3.4 years) receiving IMRT were analyzed for locoregional failure, outcomes, and toxicities. IMRT doses were 23.4Gy (n=12), 30Gy (n=1), 30.6Gy (n=5), and 36.0Gy (n=2) based on extent of resection. Five patients had tumors with MYCN amplification, and 19 had metastatic disease. All patients were treated consistently using reproducible immobilization techniques; physiological motion was assessed by 4D-CT, and target localization by cone-beam computed tomography. ICRU 62 volumetric conventions were employed based on institutional data for pediatric target volume and organ motion. Results: No patient developed primary site infield or locoregional failure at a median follow-up of 2.2 years. Distant failure (median time to distant failure 1.6 years) occurred in the brain, lungs, or skeletal sites in eight patients, five of whom died. The 2-year event-free survival was 58.5±13.3% and cumulative incidence of local and distant failures was 0% and 41.5±11.9%, respectively. Asymptomatic loose stool during RT occurred in nearly all patients, but required no intervention. Conclusions: IMRT is feasible, safe in the short term, and yields excellent locoregional control. Despite subtotal resection in some cases, locoregional control appeared to be increased by conformal radiotherapy with ICRU 62-compliant volumes. Dose escalation beyond 30.6Gy may be unnecessary with improved target volume coverage.

UR - http://www.scopus.com/inward/record.url?scp=84874952623&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874952623&partnerID=8YFLogxK

U2 - 10.1002/pbc.24350

DO - 10.1002/pbc.24350

M3 - Article

C2 - 23024112

AN - SCOPUS:84874952623

VL - 60

SP - 761

EP - 765

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 5

ER -