Newly diagnosed patients with high-risk neuroblastoma were enrolled in ANBL0532 from November 2007 to February 2012. In this report, we describe results of a preplanned comparison with COG A3973 to evaluate the potential benefit of radiation dose escalation to improve outcomes of patients with high-risk neuroblastoma and incomplete resection of their primary tumor.
#Fran laurie qarc trial#
Similar to the preceding COG clinical trial for high-risk neuroblastoma, COG A3973, evaluation of incomplete resection was performed after 5 cycles of induction chemotherapy and before stem-cell transplantation (SCT). For patients with incomplete resection, an additional boost of 14.4 Gy (for total dose of 36 Gy) was delivered only to gross residual tumor volume. All patients received 21.6 Gy of radiation to the preoperative primary tumor volume after induction chemotherapy. Given the high rates of local recurrence after incomplete surgical resection and the anticipated acceptable toxicity associated with a modest radiation dose escalation, Children’s Oncology Group (COG) ANBL0532 prospectively evaluated the potential benefit of boost radiotherapy for patients with gross residual tumor. However, these prior reports are limited by retrospective study designs and small sample sizes therefore, a large prospective cooperative group study is needed to answer this critically important question. 2, 11- 14 In particular, Simon et al 15 demonstrated delivery of 30.6 to 40 Gy to the residual tumor volume resulted in event-free survival (EFS) and OS rates similar to those in patients without residual disease after induction chemotherapy with limited acute or late toxicity, suggesting dose escalation may effectively and safely treat gross residual tumor. 4, 6, 10 Prior studies suggest that radiation dose escalation can improve outcomes for patients with high-risk neuroblastoma. New strategies are needed to decrease the risk of locoregional failure.Ĭurrent approaches to local therapy for patients with incomplete resection remain inadequate, with 5-year cumulative incidence of local progression (CILP) of approximately 20% for patients with an extent of resection < 90%. Five-year CILP, event-free survival, and overall survival were not statistically different between patients who received single SCT and boost radiotherapy in ANBL0532 and those with incomplete resection and no boost radiotherapy in A3973.īoost radiotherapy for gross residual disease does not improve local control, and this strategy is not recommended. We studied this question prospectively in the Children’s Oncology Group (COG) ANBL0532 phase III study using a historical comparison cohort, COG A3973, that underwent single stem-cell transplantation (SCT) and did not receive boost radiotherapy. Mott Children’s Hospital, University of Michigan, Ann Arbor, MIġ0Department of Pediatrics, Duke University Medical Center, Durham, NCġ1Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PAġ2Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WAĭoes increasing local dose of radiation to a residual primary tumor improve the cumulative incidence of local progression (CILP) in patients with high-risk neuroblastoma after surgery? 1Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham & Women’s Hospital, Boston Children’s Hospital, Harvard Medical School, Boston, MAĢChildren’s Oncology Group Statistics and Data Center, University of Florida, Gainesville, FLģChildren’s Oncology Group Statistics and Data Center, Monrovia, CAĤDepartment of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School, Boston, MAĥDepartment of Radiation Oncology, University of California San Francisco, San Francisco, CAĦDepartment of Radiology, Boston Children’s Hospital, Boston, MAħDepartment of Radiology, St Louis Children’s Hospital, St Louis, MOĨDepartment of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children’s Hospital, San Antonio, TXĩSection of Pediatric Surgery, Department of Surgery, C.S.
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