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Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study.

Publication ,  Journal Article
Braunstein, SE; London, WB; Kreissman, SG; Villablanca, JG; Davidoff, AM; DeSantes, K; Castleberry, RP; Murray, K; Diller, L; Matthay, K ...
Published in: Pediatr Blood Cancer
July 2019

PURPOSE: Neuroblastoma is the most common extracranial solid pediatric malignancy, with poor outcomes in high-risk disease. Standard treatment approaches employ an increasing array of aggressive multimodal therapies, of which local control with surgery and radiotherapy remains a backbone; however, the benefit of broad regional nodal irradiation remains controversial. We analyzed centrally reviewed radiation therapy data from patients enrolled on COG A3973 to evaluate the impact of primary site irradiation and the extent of regional nodal coverage stratified by extent of surgical resection. METHODS: Three hundred thirty high-risk neuroblastoma patients with centrally reviewed radiotherapy plans were analyzed. Outcome was evaluated by the extent of nodal irradiation. For the 171 patients who also underwent surgery (centrally reviewed), outcome was likewise analyzed according to the extent of resection. Overall survival (OS), event-free survival (EFS), and cumulative incidence of local progression (CILP) were examined by Kaplan-Meier, log-rank test (EFS, OS), and Grey test (CILP). RESULTS: The five-year CILP, EFS, and OS for all 330 patients receiving radiotherapy on A3973 were 8.5% ± 1.5%, 47.2% ± 3.0%, and 59.7% ± 3.0%, respectively. There were no significant differences in outcomes based on the extent of lymph node irradiation regardless of the degree of surgical resection (< 90% or ≥90%). CONCLUSION: Although local control remains a significant component of treatment of high-risk neuroblastoma, our results suggest there is no benefit of extensive lymph node irradiation, irrespective of the extent of surgical resection preceding stem cell transplant.

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Published In

Pediatr Blood Cancer

DOI

EISSN

1545-5017

Publication Date

July 2019

Volume

66

Issue

7

Start / End Page

e27736

Location

United States

Related Subject Headings

  • Survival Rate
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Male
  • Lymph Nodes
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Disease-Free Survival
 

Citation

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Braunstein, S. E., London, W. B., Kreissman, S. G., Villablanca, J. G., Davidoff, A. M., DeSantes, K., … Haas-Kogan, D. A. (2019). Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study. Pediatr Blood Cancer, 66(7), e27736. https://doi.org/10.1002/pbc.27736
Braunstein, Steve E., Wendy B. London, Susan G. Kreissman, Judith G. Villablanca, Andrew M. Davidoff, Kenneth DeSantes, Robert P. Castleberry, et al. “Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study.Pediatr Blood Cancer 66, no. 7 (July 2019): e27736. https://doi.org/10.1002/pbc.27736.
Braunstein SE, London WB, Kreissman SG, Villablanca JG, Davidoff AM, DeSantes K, et al. Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study. Pediatr Blood Cancer. 2019 Jul;66(7):e27736.
Braunstein, Steve E., et al. “Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study.Pediatr Blood Cancer, vol. 66, no. 7, July 2019, p. e27736. Pubmed, doi:10.1002/pbc.27736.
Braunstein SE, London WB, Kreissman SG, Villablanca JG, Davidoff AM, DeSantes K, Castleberry RP, Murray K, Diller L, Matthay K, Cohn SL, Shulkin B, von Allmen D, Parisi MT, Van Ryn C, Park JR, La Quaglia MP, Haas-Kogan DA. Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study. Pediatr Blood Cancer. 2019 Jul;66(7):e27736.
Journal cover image

Published In

Pediatr Blood Cancer

DOI

EISSN

1545-5017

Publication Date

July 2019

Volume

66

Issue

7

Start / End Page

e27736

Location

United States

Related Subject Headings

  • Survival Rate
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Male
  • Lymph Nodes
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Disease-Free Survival