Poster Presentation Advances in Neuroblastoma Research Congress 2016

Impact of radiotherapy and curie score on bone relapse in high-risk neuroblastoma (#220)

Kimikazu Matsumoto 1 , Chikako Kiyotani 1 , Yoko Shioda 1 , Keita Terashima 1 , Daisuke Tomizawa 1 , Motohiro Kato 1 , Tomoo Osumi 1 , Yutaka Kanamori 2 , Yasushi Fuchimoto 2 , Atsuko Nakazawa 3 , Takako Yoshioka 3 , Hiroshi Fuji 4 , Osamu Miyazaki 4 , Masayuki Kitamura 4 , Hidekazu Masaki 4
  1. Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
  2. Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo
  3. Department of Pathology, National Center for Child Health and Development, Tokyo
  4. Department of Radiology, National Center for Child Health and Development, Tokyo

Background

Our center has treated bone metastasis of high-risk neuroblastoma with severe bone destruction at diagnosis with 20-Gy radiotherapy even after disappearance of MIBG positivity at the completion of induction therapy. Our purpose of this report is to analyze the impact of Curie score (CS) and radiotherapy to the outcome of high-risk neuroblastoma.

Methods

Thirty-three consecutive patients with stage 4 neuroblastoma were treated between 2002 and 2014. Patients received induction chemotherapy with five cycles of standard agents in Japan, resection of the primary tumor, followed by high-dose chemotherapy (HDC; TT+LPAM (n=17), BU+LPAM (n=9), MEC (n=4) ) with autologous PBSCT and local irradiation. We analyzed CS at completion of induction chemotherapy.

Results

The 5-year OS and PFS for 33 patients of stage 4 neuroblastoma were 60.5+/-9.5% and 51.4+/-9.2% respectively. Three patients died of therapy-related toxicity during the protocol, so we exclude them from the analysis of bone metastasis. There was a significant EFS difference according to CS at the completion of induction chemotherapy, CS=0 (n=20) vs CS>0 (n=10), with 5-year EFS 60.2±12.3% vs 18.0±15.1% (p=0.035) respectively. Sixteen patients with CS=0 were irradiated on metastatic bone sites, and 5 of them relapsed at non-irradiated sites (n=4) or irradiated bones (n=1). In contrast, 2 patients out of 4 patients without irradiation and CS=0 relapsed at bone metastatic sites previously existed. There was no difference of EFS between irradiated and non-irradiated patients with CS=0 (p=0.738). In CS>0 patients, 9 out of 10 patients were irradiated on metastatic bone sites, but 6 patients relapsed at previously irradiated sites. Of note, 5-year EFS of patients with MYCN amplified and CS=0 (n=11) was 80.8±12.2% compared with 55.6±21.3% of patients with MYCN non-amplified and CS=0 (n=9) (p=0.130).

Conclusion

CS before HDC is useful to predict the outcome of advanced neuroblastoma as previously reported. Although we could not identify the efficacy of bone irradiation to the patients with CS=0, EFS of patients with MYCN amplified and CS=0 has been improved.