Universität zu Köln

Jazmati, Danny, Hero, Barbara, Thole-Kliesch, Theresa M., Merta, Julien, Deubzer, Hedwig E., Baeumer, Christian, Heinzelmann, Feline, Schleithoff, Stefanie Schulze, Koerber, Friederike, Eggert, Angelika ORCID: 0000-0003-3476-8184, Schwarz, Rudolf, Simon, Thorsten ORCID: 0000-0002-3425-8451 and Timmermann, Beate (2022). Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry. Curr. Oncol., 29 (11). S. 8222 - 8235. BASEL: MDPI. ISSN 1718-7729

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Abstract

Background: Despite an intensive multimodal treatment approach, approximately 50% of high-risk (HR) neuroblastoma (NB) patients experience progression. Despite the advances in targeted therapy, high-dose chemotherapy, and other systemic treatment options, radiation therapy (RT) to sites of relapsed disease can be an option to reduce tumor burden and improve chance for disease control. Methods: Patients who received salvage irradiation with proton beam therapy (PBT) for local or metastatic relapse of HR NB within the prospective registry trials KiProReg and ProReg were eligible for this retrospective analysis. Data on patient characteristics, multimodality therapy, adverse events, and oncologic endpoints were evaluated. Adverse events were assessed before, during, and after PBT according to common terminology criteria for adverse events (CTCAE) V4.0. Results: Between September 2013 and September 2020, twenty (11 male; 9 female) consecutive patients experiencing local (N = 9) or distant recurrence (N = 25) were identified for this analysis. Distant recurrences included osteomedullary (N = 11) or CNS lesions (N = 14). Salvage therapy consisted of re-induction chemo- or chemo-immuno-therapy (N = 19), surgery (N = 6), high-dose chemotherapy and stem cell transplantation (N = 13), radiation (N = 20), and concurrent systemic therapy. Systemic therapy concurrent to RT was given to six patients and included temozolomide (N = 4), carboplatine (N = 1), or anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKI) (N = 1). A median dose of 36 Gy was applied to the 34 recurrent sites. Local RT was applied to 15 patients, while five patients, received craniospinal irradiation for CNS relapse. After a median follow-up (FU) of 20 months (4-66), the estimated rate for local control, distant metastatic free survival, and overall survival at 3 years was 68.0%, 37.9%, and 61.6%, respectively. During RT, ten patients (50%) presented with a higher-grade acute hematologic adverse event. Late higher-grade sequelae included transient myelitis with transverse section (N = 2) and secondary malignancy outside of the RT field (N = 1). Conclusion: Our study demonstrates the efficacy and safety of RT/PBT for recurrent HR NB in a multimodality second-line approach. To better define the role of RT for these patients, prospective studies would be desirable.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Jazmati, Danny UNSPECIFIED UNSPECIFIED UNSPECIFIED Hero, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Thole-Kliesch, Theresa M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Merta, Julien UNSPECIFIED UNSPECIFIED UNSPECIFIED Deubzer, Hedwig E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baeumer, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Heinzelmann, Feline UNSPECIFIED UNSPECIFIED UNSPECIFIED Schleithoff, Stefanie Schulze UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Friederike UNSPECIFIED UNSPECIFIED UNSPECIFIED Eggert, Angelika UNSPECIFIED orcid.org/0000-0003-3476-8184 UNSPECIFIED Schwarz, Rudolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Simon, Thorsten UNSPECIFIED orcid.org/0000-0002-3425-8451 UNSPECIFIED Timmermann, Beate UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-687526
DOI:	10.3390/curroncol29110649
Journal or Publication Title:	Curr. Oncol.
Volume:	29
Number:	11
Page Range:	S. 8222 - 8235
Date:	2022
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	1718-7729
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NERVOUS-SYSTEM METASTASES; RADIATION-THERAPY; PHASE-II; CANCER; RADIOTHERAPY; TEMOZOLOMIDE; CHILDREN; SURVIVAL; DISEASE Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68752