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Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry

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...

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Autores principales: Jazmati, Danny, Hero, Barbara, Thole.-Kliesch, Theresa M., Merta, Julien, Deubzer, Hedwig E., Bäumer, Christian, Heinzelmann, Feline, Schleithoff, Stefanie Schulze, Koerber, Friederike, Eggert, Angelika, Schwarz, Rudolf, Simon, Thorsten, Timmermann, Beate
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689739/
https://www.ncbi.nlm.nih.gov/pubmed/36354709
http://dx.doi.org/10.3390/curroncol29110649
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author Jazmati, Danny
Hero, Barbara
Thole.-Kliesch, Theresa M.
Merta, Julien
Deubzer, Hedwig E.
Bäumer, Christian
Heinzelmann, Feline
Schleithoff, Stefanie Schulze
Koerber, Friederike
Eggert, Angelika
Schwarz, Rudolf
Simon, Thorsten
Timmermann, Beate
author_facet Jazmati, Danny
Hero, Barbara
Thole.-Kliesch, Theresa M.
Merta, Julien
Deubzer, Hedwig E.
Bäumer, Christian
Heinzelmann, Feline
Schleithoff, Stefanie Schulze
Koerber, Friederike
Eggert, Angelika
Schwarz, Rudolf
Simon, Thorsten
Timmermann, Beate
author_sort Jazmati, Danny
collection PubMed
description 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.
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spelling pubmed-96897392022-11-25 Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry Jazmati, Danny Hero, Barbara Thole.-Kliesch, Theresa M. Merta, Julien Deubzer, Hedwig E. Bäumer, Christian Heinzelmann, Feline Schleithoff, Stefanie Schulze Koerber, Friederike Eggert, Angelika Schwarz, Rudolf Simon, Thorsten Timmermann, Beate Curr Oncol Article 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. MDPI 2022-10-30 /pmc/articles/PMC9689739/ /pubmed/36354709 http://dx.doi.org/10.3390/curroncol29110649 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jazmati, Danny
Hero, Barbara
Thole.-Kliesch, Theresa M.
Merta, Julien
Deubzer, Hedwig E.
Bäumer, Christian
Heinzelmann, Feline
Schleithoff, Stefanie Schulze
Koerber, Friederike
Eggert, Angelika
Schwarz, Rudolf
Simon, Thorsten
Timmermann, Beate
Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title_full Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title_fullStr Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title_full_unstemmed Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title_short Efficacy and Feasibility of Proton Beam Therapy in Relapsed High-Risk Neuroblastoma-Experiences from the Prospective KiProReg Registry
title_sort efficacy and feasibility of proton beam therapy in relapsed high-risk neuroblastoma-experiences from the prospective kiproreg registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689739/
https://www.ncbi.nlm.nih.gov/pubmed/36354709
http://dx.doi.org/10.3390/curroncol29110649
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