Local Control and Clinical Outcome of High-risk Pediatric Neuroblastoma Patients After Receiving Multimodality Treatment and Helical Tomotherapy

Abstract

Background/Aim: The local control and clinical outcome of pediatric patients with high-risk neuroblastoma treated with tomotherapy as part of a modern multimodality paradigm was assessed. Patients and Methods: Twenty-four high-risk neuroblastoma patients who received radiotherapy (RT) to the primary site using helical tomotherapy (median 21.6 Gy) were included. Local failure (LF) was correlated with biological and clinical prognostic factors. Event-free survival (EFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Results: After a median follow-up of 43.5 months, the 3-year cumulative incidence of LF, EFS, and OS were 21.1%, 45.8%, and 62.9%, respectively. Elevated serum lactate dehydrogenase ≥1,500 U/l was associated with worse LF (p=0.02). There was no 3-year LF noted for patients with gross residual disease (GRD) who received more than 21.6 Gy. Conclusion: We demonstrated favorable local control of tomotherapy for the treatment of high-risk neuroblastoma. Dose escalation of RT for patients with GRD should be investigated.