A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma.

Autor: Gains JE; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK., Patel A; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK., Chang YC; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK., Mandeville HC; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK., Smyth G; National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, Sutton, UK., Stacey C; Radiotherapy Physics Group, University College London Hospitals NHS Foundation Trust, London, UK., Talbot J; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK., Wheatley K; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK., Gaze MN; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: https://twitter.com/@MarkGaze.
Jazyk: angličtina
Zdroj: Clinical oncology (Royal College of Radiologists (Great Britain)) [Clin Oncol (R Coll Radiol)] 2024 Jun; Vol. 36 (6), pp. e154-e162. Date of Electronic Publication: 2024 Mar 15.
DOI: 10.1016/j.clon.2024.03.004
Abstrakt: Background and Purpose: For high-risk neuroblastoma, planning target volume coverage is often compromised to respect adjacent kidney tolerance. This trial investigated whether intensity-modulated arc radiotherapy techniques (IMAT) could facilitate dose escalation better than conventional techniques.
Materials and Methods: Children with high-risk abdominal neuroblastoma referred for radiotherapy to the primary tumour site and involved regional lymph nodes were randomised to receive either standard dose (21 Gy in 14 fractions) or escalated dose (36 Gy in 24 fractions) radiotherapy. Dual planning with both a conventional anterior-posterior parallel opposed pair radiotherapy technique and an IMAT technique was performed. The quality of target volume and organ-at-risk delineation, and dosimetric plans, were externally reviewed. Dosimetric parameters were used to judge the superior technique for treatment. This feasibility trial was not powered to detect improvement in outcome with dose escalation.
Results: Between 2017 and 2020, 50 patients were randomised and dual-planned. The IMAT technique was judged more favourable in 48 patients. In all patients randomised to receive 36 Gy, IMAT would have permitted delivery of the full dose (median D50% 36.0 Gy, inter-quartile range 36.0-36.1 Gy) to the target volume, whereas dose compromise would have been required with conventional planning (median D50% 35.6 Gy, inter-quartile range 28.7-35.9 Gy).
Conclusion: IMAT facilitates safe dose escalation to 36 Gy in patients receiving radiotherapy for neuroblastoma. The value of dose escalation is now being evaluated in a current prospective phase III randomised trial.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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