Implications of Image-Defined Risk Factors and Primary Site Response on Local Control and Radiation Treatment Delivery in the Management of High Risk Neuroblastoma: Is there a Role for De-escalation of Adjuvant Primary Site Radiotherapy?

We show that successive improvements in systemic therapy have improved local relapse-free survival and overall survival in high-risk neuroblastoma, and reduced the potential need for both local and locoregional therapy. Gross disease may be successfully controlled with primary-site radiotherapy to a dose of 30.6 Gy in the context of modern multi-modality therapy. Finally, we show that International Neuroblastoma Risk Group Image Defined Risk Factors, presence/absence of residual disease, and intensity of systemic therapy may be useful in selecting patients for further primary-site radiotherapy de-escalation in future studies.

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