Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement
Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement
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DOI：
10.1016/j.ijrobp.2016.11.043
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发表时间：
2017-03-15
影响因子：
7
通讯作者：
Esiashvili, Natia
中科院分区：
文献类型：
--
作者：
Ferris, Matthew J.;Danish, Hasan;Esiashvili, Natia
目的：报告同一医院高危神经母细胞瘤患者放射治疗（RT）剂量和手术病理变量对疾病控制和总生存期（OS）的影响。方法和材料：我们对2003年1月至2014年5月期间接受RT治疗的67例高危神经母细胞瘤患者进行了回顾性研究。结果：中位随访时间为4.5年，26例（38.8%）患者远期治疗失败；其中4例局部失败。1例患者局部进展，无远处衰竭。局部控制率为92.5%，总控制率为59.5%。在局部无复发生存期（P = 0.55）、无病生存期（P = 0.22）或OS （P = 0.72）方面，未证明超过21.6 Gy的放疗剂量有任何益处。在局部无复发生存期、无病生存期和总生存期方面，手术病理淋巴结阳性、手术切缘阳性或大体残留疾病均未见不利。在大体残留病变的患者中，75%（6 / 8）在最后一次随访时没有病变迹象，2例失败的患者在远距离随访时没有病变迹象。结论：本研究中高危神经母细胞瘤患者保持了良好的局部控制，对于超过21.6 Gy的辐射剂量没有益处，对于术后大体残留疾病、手术切缘阳性或病理淋巴结阳性没有不利影响。虽然必须牢记对罕见疾病进行回顾性评价的局限性，但在某些亚组中人数较少，似乎只有在特殊情况下才应考虑剂量增加。(C) 2016 Elsevier Inc.版权所有。
Purpose: To report the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution.Methods and Materials: We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May 2014.Results: At a median follow-up of 4.5 years, 26 patients (38.8%) failed distantly; 4 of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6 Gy with respect to local relapse-free survival (P =.55), disease-free survival (P =.22), or OS (P =.72). With respect to local relapse-free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly.Conclusions: Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6 Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances. (C) 2016 Elsevier Inc. All rights reserved.