TY - JOUR
T1 - Radical skeletal metastatic site irradiation in highrisk neuroblastoma
T2 - systematic review and proposal for a randomised trial: a report from the SIOPEN Radiotherapy Committee
AU - Keshwani, Karimali
AU - Boterberg, Tom
AU - Dieckmann, Karin
AU - Janssens, Geert O.
AU - Laprie, Anne
AU - Timmermann, Beate
AU - Gaze, Mark N.
N1 - Funding Information:
Dr. Gaze MN is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and the Radiation Research Unit at the Cancer Research UK City of London Centre Award [C7893/A28990].
Publisher Copyright:
© The Author(s) 2023.
PY - 2023/2/14
Y1 - 2023/2/14
N2 - Aim: Neuroblastoma has a variable outcome depending on age, stage, and molecular pathology. Distant metastatic disease is the central feature of high-risk disease. Recommendations for irradiating persistent metastatic deposits with curative intent after systemic therapy vary. It is unclear to what extent this practice may improve local control or survival. This study systematically reviewed the evidence for skeletal metastatic site irradiation and made evidence-based recommendations for clinical practice. Methods: We systematically reviewed the literature on radical radiotherapy of persistent metastases after chemotherapy. The aim was to determine whether a position could be taken regarding metastatic site irradiation in combined modality treatment protocols aiming for a cure and whether recommendations could be formulated Results: The initial search yielded 445 results. After the title and abstract review, 13 full papers were retrieved. Ten papers were found suitable for data extraction. One additional paper was identified. All 11 were graded as Centre for Evidence-Based Medicine Step 4 in quality; there was no high-level evidence. There are suggestions of benefit for skeletal site irradiation in high-risk neuroblastoma; however, there is no certainty, and it was not possible to recommend a particular treatment policy. Conclusion: We recommend that consideration is given to a randomised evaluation of the benefits of radiotherapy to a limited number of residual post-induction-chemotherapy metastatic sites in good responders. This practice could be incorporated as an amendment to existing trials.
AB - Aim: Neuroblastoma has a variable outcome depending on age, stage, and molecular pathology. Distant metastatic disease is the central feature of high-risk disease. Recommendations for irradiating persistent metastatic deposits with curative intent after systemic therapy vary. It is unclear to what extent this practice may improve local control or survival. This study systematically reviewed the evidence for skeletal metastatic site irradiation and made evidence-based recommendations for clinical practice. Methods: We systematically reviewed the literature on radical radiotherapy of persistent metastases after chemotherapy. The aim was to determine whether a position could be taken regarding metastatic site irradiation in combined modality treatment protocols aiming for a cure and whether recommendations could be formulated Results: The initial search yielded 445 results. After the title and abstract review, 13 full papers were retrieved. Ten papers were found suitable for data extraction. One additional paper was identified. All 11 were graded as Centre for Evidence-Based Medicine Step 4 in quality; there was no high-level evidence. There are suggestions of benefit for skeletal site irradiation in high-risk neuroblastoma; however, there is no certainty, and it was not possible to recommend a particular treatment policy. Conclusion: We recommend that consideration is given to a randomised evaluation of the benefits of radiotherapy to a limited number of residual post-induction-chemotherapy metastatic sites in good responders. This practice could be incorporated as an amendment to existing trials.
KW - Curative intent
KW - high-risk neuroblastoma
KW - radical radiotherapy
KW - skeletal metastases
UR - http://www.scopus.com/inward/record.url?scp=85165427287&partnerID=8YFLogxK
U2 - 10.20517/2394-4722.2022.32
DO - 10.20517/2394-4722.2022.32
M3 - Review article
AN - SCOPUS:85165427287
SN - 2394-4722
VL - 9
JO - Journal of Cancer Metastasis and Treatment
JF - Journal of Cancer Metastasis and Treatment
M1 - A27
ER -