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Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions
•RT margins and doses for high-risk neuroblastoma vary across studies.•Highly-conformal IGRT with reduced margins and boost on residue ≥ 1 cm3 was applied.•5-years LRF rate of 7.8 % was excellent and comparable for residue
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| Published in: | Radiotherapy and oncology 2025-01, Vol.202, p.110604, Article 110604 |
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| creator | 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. |
| description | •RT margins and doses for high-risk neuroblastoma vary across studies.•Highly-conformal IGRT with reduced margins and boost on residue ≥ 1 cm3 was applied.•5-years LRF rate of 7.8 % was excellent and comparable for residue |
| doi_str_mv | 10.1016/j.radonc.2024.110604 |
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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 cm3 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 cm3 vs. ≥ 1 cm3 (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [131I]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 cm3, 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 cm3 vs. ≥ 1 cm3 (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 cm3 demonstrated excellent locoregional control, comparable to modern literature.</description><identifier>ISSN: 0167-8140</identifier><identifier>ISSN: 1879-0887</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2024.110604</identifier><identifier>PMID: 39481605</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Abdominal radiotherapy ; Adolescent ; Child ; Child, Preschool ; Female ; High-risk neuroblastoma ; Highly conformal radiotherapy ; Humans ; Image-guided radiotherapy ; Infant ; Locoregional failure ; Male ; Neoplasm, Residual - radiotherapy ; Neuroblastoma - diagnostic imaging ; Neuroblastoma - pathology ; Neuroblastoma - radiotherapy ; Pattern of failure ; Radiotherapy boost ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted - methods ; Radiotherapy, Conformal - methods ; Radiotherapy, Image-Guided - methods ; Radiotherapy, Intensity-Modulated - methods ; Residue ; Retrospective Studies ; Tertiary hospital</subject><ispartof>Radiotherapy and oncology, 2025-01, Vol.202, p.110604, Article 110604</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c287t-777e4c4e3c5b70b44f6910c990baf56931472625c4801e28ce9cebbb844e9bc53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39481605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samim, Atia</creatorcontrib><creatorcontrib>Littooij, Annemieke S.</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>de Keizer, Bart</creatorcontrib><creatorcontrib>van der Steeg, Alida F.W.</creatorcontrib><creatorcontrib>Fajardo, Raquel Dávila</creatorcontrib><creatorcontrib>Kraal, Kathelijne C.J.M.</creatorcontrib><creatorcontrib>Dierselhuis, Miranda P.</creatorcontrib><creatorcontrib>van Eijkelenburg, Natasha K.A.</creatorcontrib><creatorcontrib>van Grotel, Martine</creatorcontrib><creatorcontrib>Polak, Roel</creatorcontrib><creatorcontrib>van de Ven, Cornelis P.</creatorcontrib><creatorcontrib>Wijnen, Marc H.W.A.</creatorcontrib><creatorcontrib>Seravalli, Enrica</creatorcontrib><creatorcontrib>Willemsen-Bosman, Mirjam E.</creatorcontrib><creatorcontrib>van Noesel, Max M.</creatorcontrib><creatorcontrib>Tytgat, Godelieve A.M.</creatorcontrib><creatorcontrib>Janssens, Geert O.</creatorcontrib><title>Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>•RT margins and doses for high-risk neuroblastoma vary across studies.•Highly-conformal IGRT with reduced margins and boost on residue ≥ 1 cm3 was applied.•5-years LRF rate of 7.8 % was excellent and comparable for residue < 1 cm3 vs. ≥ 1 cm3.•LRF was observed in 6/77 patients of whom only 2 had an isolated failure.•Residual activity on nuclear- and MRI[DWI]-scans was not predictive for LRF.
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 cm3 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 cm3 vs. ≥ 1 cm3 (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [131I]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 cm3, 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 cm3 vs. ≥ 1 cm3 (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 cm3 demonstrated excellent locoregional control, comparable to modern literature.</description><subject>Abdominal radiotherapy</subject><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>High-risk neuroblastoma</subject><subject>Highly conformal radiotherapy</subject><subject>Humans</subject><subject>Image-guided radiotherapy</subject><subject>Infant</subject><subject>Locoregional failure</subject><subject>Male</subject><subject>Neoplasm, Residual - radiotherapy</subject><subject>Neuroblastoma - diagnostic imaging</subject><subject>Neuroblastoma - pathology</subject><subject>Neuroblastoma - radiotherapy</subject><subject>Pattern of failure</subject><subject>Radiotherapy boost</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy Planning, Computer-Assisted - methods</subject><subject>Radiotherapy, Conformal - methods</subject><subject>Radiotherapy, Image-Guided - methods</subject><subject>Radiotherapy, Intensity-Modulated - methods</subject><subject>Residue</subject><subject>Retrospective Studies</subject><subject>Tertiary hospital</subject><issn>0167-8140</issn><issn>1879-0887</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNp9kcuO1DAQRS0EYnoG_gAhL1mQppw4cbxBQiNeUktsYG35UUm7SezGTgb1v_CxeMjAklWVVOfecvkS8oLBngHr3pz2SbsY7L6Gmu8Zgw74I7JjvZAV9L14THYFE1XPOFyR65xPAFBDI56Sq0bynnXQ7sivQ7Qx4ehj0BO1MSwpTtQHevTjsUo-f6cB1xTNpPMSZ03X7MP4ZzpdqsIPMc1F6Wc9YjWu3qGj5WE-LkdM-nx5TX_65UgTutWW0azT6EOmOjiqqYkxL9TFjLT4FCh7txa3qTQx5GfkyaCnjM8f6g359uH919tP1eHLx8-37w6VrXuxVEII5JZjY1sjwHA-dJKBlRKMHtpONoyLuqtby3tgWPcWpUVjTM85SmPb5oa82nzPKf5YMS9q9tniNOmAcc2qYXUDogHZFZRvqE0x54SDOqdye7ooBuo-F3VSWy7qPhe15VJkLx82rGZG90_0N4gCvN0ALHfeeUwqW4-hfJlPaBflov__ht-P2aPu</recordid><startdate>202501</startdate><enddate>202501</enddate><creator>Samim, Atia</creator><creator>Littooij, Annemieke S.</creator><creator>Peters, Max</creator><creator>de Keizer, Bart</creator><creator>van der Steeg, Alida F.W.</creator><creator>Fajardo, Raquel Dávila</creator><creator>Kraal, Kathelijne C.J.M.</creator><creator>Dierselhuis, Miranda P.</creator><creator>van Eijkelenburg, Natasha K.A.</creator><creator>van Grotel, Martine</creator><creator>Polak, Roel</creator><creator>van de Ven, Cornelis P.</creator><creator>Wijnen, Marc H.W.A.</creator><creator>Seravalli, Enrica</creator><creator>Willemsen-Bosman, Mirjam E.</creator><creator>van Noesel, Max M.</creator><creator>Tytgat, Godelieve A.M.</creator><creator>Janssens, Geert O.</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202501</creationdate><title>Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c287t-777e4c4e3c5b70b44f6910c990baf56931472625c4801e28ce9cebbb844e9bc53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Abdominal radiotherapy</topic><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>High-risk neuroblastoma</topic><topic>Highly conformal radiotherapy</topic><topic>Humans</topic><topic>Image-guided radiotherapy</topic><topic>Infant</topic><topic>Locoregional failure</topic><topic>Male</topic><topic>Neoplasm, Residual - radiotherapy</topic><topic>Neuroblastoma - diagnostic imaging</topic><topic>Neuroblastoma - pathology</topic><topic>Neuroblastoma - radiotherapy</topic><topic>Pattern of failure</topic><topic>Radiotherapy boost</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy Planning, Computer-Assisted - methods</topic><topic>Radiotherapy, Conformal - methods</topic><topic>Radiotherapy, Image-Guided - methods</topic><topic>Radiotherapy, Intensity-Modulated - methods</topic><topic>Residue</topic><topic>Retrospective Studies</topic><topic>Tertiary hospital</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Samim, Atia</creatorcontrib><creatorcontrib>Littooij, Annemieke S.</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>de Keizer, Bart</creatorcontrib><creatorcontrib>van der Steeg, Alida F.W.</creatorcontrib><creatorcontrib>Fajardo, Raquel Dávila</creatorcontrib><creatorcontrib>Kraal, Kathelijne C.J.M.</creatorcontrib><creatorcontrib>Dierselhuis, Miranda P.</creatorcontrib><creatorcontrib>van Eijkelenburg, Natasha K.A.</creatorcontrib><creatorcontrib>van Grotel, Martine</creatorcontrib><creatorcontrib>Polak, Roel</creatorcontrib><creatorcontrib>van de Ven, Cornelis P.</creatorcontrib><creatorcontrib>Wijnen, Marc H.W.A.</creatorcontrib><creatorcontrib>Seravalli, Enrica</creatorcontrib><creatorcontrib>Willemsen-Bosman, Mirjam E.</creatorcontrib><creatorcontrib>van Noesel, Max M.</creatorcontrib><creatorcontrib>Tytgat, Godelieve A.M.</creatorcontrib><creatorcontrib>Janssens, Geert O.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Samim, Atia</au><au>Littooij, Annemieke S.</au><au>Peters, Max</au><au>de Keizer, Bart</au><au>van der Steeg, Alida F.W.</au><au>Fajardo, Raquel Dávila</au><au>Kraal, Kathelijne C.J.M.</au><au>Dierselhuis, Miranda P.</au><au>van Eijkelenburg, Natasha K.A.</au><au>van Grotel, Martine</au><au>Polak, Roel</au><au>van de Ven, Cornelis P.</au><au>Wijnen, Marc H.W.A.</au><au>Seravalli, Enrica</au><au>Willemsen-Bosman, Mirjam E.</au><au>van Noesel, Max M.</au><au>Tytgat, Godelieve A.M.</au><au>Janssens, Geert O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2025-01</date><risdate>2025</risdate><volume>202</volume><spage>110604</spage><pages>110604-</pages><artnum>110604</artnum><issn>0167-8140</issn><issn>1879-0887</issn><eissn>1879-0887</eissn><abstract>•RT margins and doses for high-risk neuroblastoma vary across studies.•Highly-conformal IGRT with reduced margins and boost on residue ≥ 1 cm3 was applied.•5-years LRF rate of 7.8 % was excellent and comparable for residue < 1 cm3 vs. ≥ 1 cm3.•LRF was observed in 6/77 patients of whom only 2 had an isolated failure.•Residual activity on nuclear- and MRI[DWI]-scans was not predictive for LRF.
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 cm3 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 cm3 vs. ≥ 1 cm3 (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [131I]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 cm3, 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 cm3 vs. ≥ 1 cm3 (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 cm3 demonstrated excellent locoregional control, comparable to modern literature.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>39481605</pmid><doi>10.1016/j.radonc.2024.110604</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal radiotherapy Adolescent Child Child, Preschool Female High-risk neuroblastoma Highly conformal radiotherapy Humans Image-guided radiotherapy Infant Locoregional failure Male Neoplasm, Residual - radiotherapy Neuroblastoma - diagnostic imaging Neuroblastoma - pathology Neuroblastoma - radiotherapy Pattern of failure Radiotherapy boost Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Conformal - methods Radiotherapy, Image-Guided - methods Radiotherapy, Intensity-Modulated - methods Residue Retrospective Studies Tertiary hospital |
| title | Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions |
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