Pediatric Patients with High-risk Neuroblastoma with Multiple CNS Relapses Can Safely be Treated with Reirradiation as part of Multimodality Treatment
Kathryn Tringale, MD, MS
By Christina Okoye, MD
While radiation can be efficacious when treating patients with high-risk neuroblastoma, concerns about late effects, particularly in the central nervous system (CNS), highlight the importance of understanding when and how radiation can be delivered safely while maximizing efficacy and long-term disease control. With this in mind, Tringale et al. reviewed their institutional experience with high-risk neuroblastoma, evaluating outcomes for those treated after their initial CNS relapse with craniospinal irradiation (CSI) with or without a focal boost, while also reviewing overall management strategies for those who experienced a second CNS relapse. At a median follow up of 4.12 years, investigators determined 29% of patients experienced a CNS relapse after initial CSI-based radiotherapy and 55% died during the follow-up period. While no significant predictors of subsequent relapse were found, the presence of a CNS relapse after CSI-based treatment was associated with a significantly increased risk of death (OR 2.0, 95% CI [1.2, 3.3], p=0.004). Management of subsequent relapses often involved a local therapy (81%), most frequently with both surgery and radiation (46%) or radiation alone (19%), while the radiotherapy was typically delivered with a hypofractionated regimen. Despite multiple courses of radiotherapy, no episodes of radionecrosis were observed in cases of re-irradiation.
In conclusion, investigators confirmed the poor prognostic implications of a second relapse after initial salvage CSI-based radiotherapy for high-risk neuroblastoma, though they remained encouraged that long-term survivors do exist, particularly after multimodality salvage treatment typically consisting of surgery and hypofractionated radiotherapy.
Long-term Survivors Receive Multimodality Treatment of Second Central Nervous System Relapse in Pediatric Patients with Neuroblastoma was presented on Saturday, October 24, as part of Quick Pitch (QP) 04.
Published on: October 25, 2020