Samim Atia, Littooij Annemieke S, Peters Max, de Keizer Bart, van der Steeg Alida F W, Fajardo Raquel Dávila, Kraal Kathelijne C J M, Dierselhuis Miranda P, van Eijkelenburg Natasha K A, van Grotel Martine, Polak Roel, van de Ven Cornelis P, Wijnen Marc H W A, Seravalli Enrica, Willemsen-Bosman Mirjam E, van Noesel Max M, Tytgat Godelieve A M, Janssens Geert O
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Radiother Oncol. 2025 Jan;202:110604. doi: 10.1016/j.radonc.2024.110604. Epub 2024 Oct 29.
Radiotherapy protocols for high-risk neuroblastoma (HR-NBL) vary across international studies. The purpose of this study was to evaluate the locoregional control in a national HR-NBL cohort treated with highly-conformal image-guided radiotherapy (IGRT), using reduced margins, and a boost dose for residual lesions.
Patients treated with radiotherapy as part of first-line HR-NBL treatment between 2015 and 2022 were eligible. To obtain clinical, internal, and planning target volumes, +0.5 cm, 4DCT-based, and + 0.3/0.5 cm margins, respectively, were added to the edited gross tumour volumes. Prescription dose was 21.6/1.8 Gy, followed by 14.4/1.8 Gy for any residual lesions measuring ≥ 1 cm at the time of radiotherapy planning. Intensity-modulated arc therapy was combined with daily cone beam CT-based online patient position verification. Locoregional failure (LRF) rates were compared for the presence of residual lesions < 1 cm vs. ≥ 1 cm (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [I]mIBG therapy, response to induction chemotherapy, interval to radiotherapy onset, and metastatic site irradiation.
Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm, IQR 4.8-29.9) with activity visible on 17 nuclear- and 10 MRI-scans. Five-year LRF rate was 7.8 % (95 % confidence interval 1.8-13.8), and not significantly different between those with residual lesions < 1 cm vs. ≥ 1 cm (6.4 % vs. 14.3 %, respectively, p = 0.27), or any of the other variables. All 6 LRFs (2 isolated, 4 combined) occurred < 1.5 years post-radiotherapy.
In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm demonstrated excellent locoregional control, comparable to modern literature.
高危神经母细胞瘤（HR-NBL）的放射治疗方案在国际研究中各不相同。本研究的目的是评估在一个接受高剂量适形图像引导放射治疗（IGRT）、采用缩小边界并对残留病灶给予加量照射的全国HR-NBL队列中的局部区域控制情况。
符合条件的患者为2015年至2022年间作为一线HR-NBL治疗一部分接受放射治疗的患者。为获得临床靶区、内部靶区和计划靶区体积，分别在编辑后的大体肿瘤体积基础上增加+0.5 cm、基于4DCT的边界以及+0.3/0.5 cm边界。处方剂量为21.6/1.8 Gy，对于放射治疗计划时测量直径≥1 cm的任何残留病灶，随后给予14.4/1.8 Gy。调强弧形放疗与基于每日锥形束CT的在线患者体位验证相结合。比较放射治疗前残留病灶<1 cm与≥1 cm（在核扫描和MRI[扩散加权成像]扫描上有无局部区域活性）、诊断时年龄、MYCN状态、[I]间碘苄胍治疗、诱导化疗反应、放射治疗开始间隔时间以及转移部位照射的局部区域失败（LRF）率。
在纳入的77例患者中，34例有残留病灶（中位体积：10.0 cm，四分位间距4.8 - 29.9），17例核扫描和10例MRI扫描可见活性。五年LRF率为7.8%（95%置信区间1.8 - 13.8），残留病灶<1 cm与≥1 cm的患者之间（分别为6.4%和14.3%，p = 0.27）或任何其他变量之间无显著差异。所有6例LRF（2例孤立性，4例合并性）均发生在放射治疗后<1.5年。
在HR-NBL中，采用缩小边界并对直径≥1 cm的残留病灶给予加量照射的IGRT显示出优异的局部区域控制，与现代文献报道相当。
