Local control with multimodality therapy for Stage 4 neuroblastoma

Suzanne L. Wolden, Smitha V. Gollamudi, Brian H. Kushner, Michael Laquaglia, Kim Kramer, Nancy Rosen, Sara Abramson, Nai Kong V. Cheung

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Purpose: To evaluate the efficacy of 21 Gy hyperfractionated radiotherapy for local control in conjunction with surgery and intensive systemic therapy for patients with Stage 4 neuroblastoma. Methods and Materials: After achieving a partial or complete remission, 47 children, ages 1-10 years, with Stage 4 neuroblastoma were treated on four consecutive institutional protocols (N4-N7) with dose-intensive multi-agent chemotherapy, maximal surgical debulking, and hyperfractionated radiotherapy (1.5 Gy twice a day to 21 Gy). Radiotherapy fields encompassed the initial tumor volume and regional lymph nodes plus a 3-cm margin. This was followed by consolidation with either autologous bone marrow transplantation (N4 and N5) or immunotherapy (N6 and N7). Results: Forty-five of 47 patients had a complete response to surgery and chemotherapy prior to radiotherapy. Five-year actuarial rates of local control, progression-free survival, and overall survival were 84%, 40%, and 45%, respectively. Among 26 patients who relapsed, 1 failed only at the primary site, 22 developed distant metastases exclusively, and 3 had both local and distant failures. There were no acute complications of radiotherapy. Conclusion: Hyperfractionated radiotherapy to 21 Gy, in conjunction with dose-intensive systemic therapy and aggressive surgical resection, is well tolerated and is associated with durable local control for most patients with Stage 4 neuroblastoma. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)969-974
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number4
StatePublished - Mar 1 2000
Externally publishedYes


  • Hyperfractionation
  • Local control
  • Neuroblastoma
  • Radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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