Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions

Atia Samim; Annemieke S. Littooij; Max Peters; Bart de Keizer; Alida F.W. van der Steeg; Raquel Dávila Fajardo; Kathelijne C.J.M. Kraal; Miranda P. Dierselhuis; Natasha K.A. van Eijkelenburg; Martine van Grotel; Roel Polak; Cornelis P. van de Ven; Marc H.W.A. Wijnen; Enrica Seravalli; Mirjam E. Willemsen-Bosman; Max M. van Noesel; Godelieve A.M. Tytgat; Geert O. Janssens

doi:10.1016/j.radonc.2024.110604

Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions

Atia Samim
, Annemieke S. Littooij
, Max Peters
, Bart de Keizer
, Alida F.W. van der Steeg
, Raquel Dávila Fajardo
, Kathelijne C.J.M. Kraal
, Miranda P. Dierselhuis
, Natasha K.A. van Eijkelenburg
, Martine van Grotel
, Roel Polak
, Cornelis P. van de Ven
, Marc H.W.A. Wijnen
, Enrica Seravalli
, Mirjam E. Willemsen-Bosman
, Max M. van Noesel
, Godelieve A.M. Tytgat
, Geert O. Janssens

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

INTRODUCTION: 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.

MATERIALS AND METHODS: 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 3 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 3 vs. ≥ 1 cm 3 (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.

RESULTS: Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm 3, 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 3 vs. ≥ 1 cm 3 (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.

CONCLUSION: In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm 3 demonstrated excellent locoregional control, comparable to modern literature.

Original language	English
Article number	110604
Journal	Radiotherapy and Oncology
Volume	202
DOIs	https://doi.org/10.1016/j.radonc.2024.110604
Publication status	Published - Jan 2025

Keywords

Abdominal radiotherapy
High-risk neuroblastoma
Highly conformal radiotherapy
Image-guided radiotherapy
Locoregional failure
Pattern of failure
Radiotherapy boost
Residue
Tertiary hospital
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted/methods
Radiotherapy, Intensity-Modulated/methods
Humans
Child, Preschool
Infant
Male
Radiotherapy, Conformal/methods
Radiotherapy, Image-Guided/methods
Adolescent
Female
Retrospective Studies
Neuroblastoma/radiotherapy
Child
Neoplasm, Residual/radiotherapy

Access to Document

10.1016/j.radonc.2024.110604

Cite this

Samim, A., Littooij, A. S., Peters, M., de Keizer, B., van der Steeg, A. F. W., Fajardo, R. D., Kraal, K. C. J. M., Dierselhuis, M. P., van Eijkelenburg, N. K. A., van Grotel, M., Polak, R., van de Ven, C. P., Wijnen, M. H. W. A., Seravalli, E., Willemsen-Bosman, M. E., van Noesel, M. M., Tytgat, G. A. M., & Janssens, G. O. (2025). Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions. Radiotherapy and Oncology, 202, Article 110604. https://doi.org/10.1016/j.radonc.2024.110604

@article{4bb6236703474d16a793e8196f79c24f,

title = "Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions",

abstract = "INTRODUCTION: 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.MATERIALS AND METHODS: 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 3 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 3 vs. ≥ 1 cm 3 (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. RESULTS: Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm 3, 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 3 vs. ≥ 1 cm 3 (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. CONCLUSION: In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm 3 demonstrated excellent locoregional control, comparable to modern literature. ",

keywords = "Abdominal radiotherapy, High-risk neuroblastoma, Highly conformal radiotherapy, Image-guided radiotherapy, Locoregional failure, Pattern of failure, Radiotherapy boost, Residue, Tertiary hospital, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted/methods, Radiotherapy, Intensity-Modulated/methods, Humans, Child, Preschool, Infant, Male, Radiotherapy, Conformal/methods, Radiotherapy, Image-Guided/methods, Adolescent, Female, Retrospective Studies, Neuroblastoma/radiotherapy, Child, Neoplasm, Residual/radiotherapy",

author = "Atia Samim and Littooij, \{Annemieke S.\} and Max Peters and \{de Keizer\}, Bart and \{van der Steeg\}, \{Alida F.W.\} and Fajardo, \{Raquel D{\'a}vila\} and Kraal, \{Kathelijne C.J.M.\} and Dierselhuis, \{Miranda P.\} and \{van Eijkelenburg\}, \{Natasha K.A.\} and \{van Grotel\}, Martine and Roel Polak and \{van de Ven\}, \{Cornelis P.\} and Wijnen, \{Marc H.W.A.\} and Enrica Seravalli and Willemsen-Bosman, \{Mirjam E.\} and \{van Noesel\}, \{Max M.\} and Tytgat, \{Godelieve A.M.\} and Janssens, \{Geert O.\}",

year = "2025",

month = jan,

doi = "10.1016/j.radonc.2024.110604",

language = "English",

volume = "202",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

Samim, A, Littooij, AS, Peters, M, de Keizer, B, van der Steeg, AFW, Fajardo, RD, Kraal, KCJM, Dierselhuis, MP , van Eijkelenburg, NKA, van Grotel, M, Polak, R, van de Ven, CP, Wijnen, MHWA, Seravalli, E, Willemsen-Bosman, ME, van Noesel, MM , Tytgat, GAM & Janssens, GO 2025, 'Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions', Radiotherapy and Oncology, vol. 202, 110604. https://doi.org/10.1016/j.radonc.2024.110604

TY - JOUR

T1 - Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions

AU - Samim, Atia

AU - Littooij, Annemieke S.

AU - Peters, Max

AU - de Keizer, Bart

AU - van der Steeg, Alida F.W.

AU - Fajardo, Raquel Dávila

AU - Kraal, Kathelijne C.J.M.

AU - Dierselhuis, Miranda P.

AU - van Eijkelenburg, Natasha K.A.

AU - van Grotel, Martine

AU - Polak, Roel

AU - van de Ven, Cornelis P.

AU - Wijnen, Marc H.W.A.

AU - Seravalli, Enrica

AU - Willemsen-Bosman, Mirjam E.

AU - van Noesel, Max M.

AU - Tytgat, Godelieve A.M.

AU - Janssens, Geert O.

PY - 2025/1

Y1 - 2025/1

N2 - INTRODUCTION: 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.MATERIALS AND METHODS: 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 3 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 3 vs. ≥ 1 cm 3 (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. RESULTS: Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm 3, 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 3 vs. ≥ 1 cm 3 (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. CONCLUSION: In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm 3 demonstrated excellent locoregional control, comparable to modern literature.

AB - INTRODUCTION: 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.MATERIALS AND METHODS: 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 3 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 3 vs. ≥ 1 cm 3 (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. RESULTS: Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm 3, 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 3 vs. ≥ 1 cm 3 (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. CONCLUSION: In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm 3 demonstrated excellent locoregional control, comparable to modern literature.

KW - Abdominal radiotherapy

KW - High-risk neuroblastoma

KW - Highly conformal radiotherapy

KW - Image-guided radiotherapy

KW - Locoregional failure

KW - Pattern of failure

KW - Radiotherapy boost

KW - Residue

KW - Tertiary hospital

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Radiotherapy, Intensity-Modulated/methods

KW - Humans

KW - Child, Preschool

KW - Infant

KW - Male

KW - Radiotherapy, Conformal/methods

KW - Radiotherapy, Image-Guided/methods

KW - Adolescent

KW - Female

KW - Retrospective Studies

KW - Neuroblastoma/radiotherapy

KW - Child

KW - Neoplasm, Residual/radiotherapy

UR - https://www.scopus.com/pages/publications/85208109793

UR - https://www.mendeley.com/catalogue/1d93346c-42ae-3b7e-8a8e-5b6fb0cebd39/

U2 - 10.1016/j.radonc.2024.110604

DO - 10.1016/j.radonc.2024.110604

M3 - Article

C2 - 39481605

AN - SCOPUS:85208109793

SN - 0167-8140

VL - 202

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 110604

ER -

Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions

Abstract

Keywords

Access to Document

Fingerprint

Cite this