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Hypofractionated Palliative Radiotherapy for Relapsed and Refractory High-Risk Neuroblastoma
Ellery Koelker-Wolfe1, Karen J Marcus1, Steven G DuBois2
1Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Current Oncology (Toronto, Ont.)
|March 26, 2025
Summary
Palliative hypofractionated radiotherapy (hypo-RT) shows similar outcomes to conventional RT for high-risk neuroblastoma. This approach can be considered for improved quality of life in patients with relapsed/refractory disease.
Area of Science:
- Oncology
- Radiotherapy
- Pediatric Cancer
Background:
- Palliative radiotherapy (RT) is common for relapsed/refractory high-risk neuroblastoma (HR-NBL).
- Outcomes after palliative hypofractionated RT (hypo-RT) are not well-defined.
Purpose of the Study:
- To compare the effectiveness of palliative hypo-RT versus conventional RT (conv-RT) in patients with HR-NBL.
- To evaluate in-field progression and clinical response rates between the two RT fractionation methods.
Main Methods:
- Retrospective multi-institutional study of 38 HR-NBL patients receiving palliative RT.
- Defined hypo-RT as >2 Gy/fraction and conv-RT as ≤2 Gy/fraction.
- Analyzed cumulative incidence of in-field progression and clinical response using Cox proportional hazards model and Gray's test.
Main Results:
- No significant difference in cumulative incidence of in-field progression between hypo-RT (30% at 10 months) and conv-RT (20% at 10 months; p=0.80).
- Clinical response rates were similar (92% conv-RT vs. 90% hypo-RT; p=1.00).
- No grade ≥4 toxicities observed; MYCN amplification was associated with longer time to in-field progression (HR: 0.20; p=0.020).
Conclusions:
- Palliative hypo-RT and conv-RT demonstrate comparable outcomes in HR-NBL.
- Hypo-RT is a viable option for palliative care in HR-NBL, potentially improving patient quality of life due to shorter treatment duration.
