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Managing local‐regional failure in children with high‐risk neuroblastoma: A single institution experience
Author(s) -
Dove Austin P.,
Manole BogdanAlexandru,
Wakefield Daniel V.,
Cross Shane J.,
Doubrovin Michael,
Shulkin Barry L.,
Merchant Thomas E.,
Davidoff Andrew M.,
Furman Wayne L.,
Krasin Matthew J.,
Santana Victor M.,
Lucas John T.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27408
Subject(s) - medicine , radiation therapy , salvage therapy , context (archaeology) , hazard ratio , surgery , chemotherapy , confidence interval , paleontology , biology
Background Intensification of systemic therapy for high‐risk neuroblastoma (HRNB) has resulted in improved local control and overall survival (OS) leaving potential for de‐escalation of primary site radiotherapy. The utility of primary site de‐escalation should be evaluated in the context of potential for successful local‐regional salvage. We evaluated salvage strategies and outcomes in patients with HRNB with local‐regional recurrence as a component of first failure. Methods Twenty of 89 patients with HRNB experienced local‐regional recurrence as a component of first relapse after chemotherapy, radiotherapy, surgery, and stem cell transplant from 1997 to 2013. We reviewed salvage therapy strategies and disease control, and report on the impact of local therapy as salvage for local‐regional relapse. Results Six of 20 patients with local‐regional failure (LRF) were alive after a median follow‐up of 13 years (range, 0.9‐25.2 years). Median OS was 4.6 years (95% CI, 0.6 to not reached) versus 0.6 years (95% CI, 0.05‐2.6) after LRF with and without distant failure, respectively ( P = 0.03). OS in patients receiving salvage radiotherapy was comparable to those receiving initial adjuvant but no salvage radiotherapy. Time to first failure and death was significantly impacted by the intensity of frontline systemic therapy ( P = 0.03). Salvage radiotherapy reduced the hazard for subsequent LRF (hazard ratio 0.3, 95% CI 0.1‐0.9, P = 0.04) but not OS ( P = 0.07). Conclusions Our study highlights the potential of local control strategies at first failure in patients with LRF when primary site radiotherapy was initially omitted, and delineates potential selection factors which may further improve the therapeutic ratio.