Clinical results of proton beam therapy for advanced neuroblastomaReport as inadecuate

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Radiation Oncology

, 8:142

First Online: 12 June 2013Received: 18 January 2013Accepted: 01 June 2013DOI: 10.1186-1748-717X-8-142

Cite this article as: Oshiro, Y., Mizumoto, M., Okumura, T. et al. Radiat Oncol 2013 8: 142. doi:10.1186-1748-717X-8-142


PurposeTo evaluate the efficacy of proton beam therapy PBT for pediatric patients with advanced neuroblastoma.

MethodsPBT was conducted at 21 sites in 14 patients with neuroblastoma from 1984 to 2010. Most patients were difficult to treat with photon radiotherapy. Two and 6 patients were classified into stages 3 and 4, respectively, and 6 patients had recurrent disease. Seven of the 8 patients who received PBT as the initial treatment were classified as the high risk group. Twelve patients had gross residual disease before PBT and 2 had undergone intraoperative radiotherapy before PBT. Five patients received PBT for multiple sites, including remote metastases. Photon radiotherapy was used in combination with PBT for 3 patients. The PBT doses ranged from 19.8 to 45.5 GyE median: 30.6 GyE.

ResultsSeven patients are alive with no evidence of disease, 1 is alive with disease progression, and 6 died due to the tumor. Recurrence in the treatment field was not observed and the 3-year locoregional control rate was 82%. Severe acute radiotoxicity was not observed, but 1 patient had narrowing of the aorta and asymptomatic vertebral compression fracture at 28 years after PBT, and hair loss was prolonged in one patient.

ConclusionPBT may be a better alternative to photon radiotherapy for children with advanced neuroblastoma, and may be conducted safely for patients with neuroblastoma that is difficult to manage using photon beams.

KeywordsNeuroblastoma Proton therapy Radiotherapy Late toxicity Pediatrics AbbreviationsPBTProton beam therapy

INSSInternational Neuroblastoma Staging System

INRGThe international neuroblastoma risk group

IORTIntraoperative radiotherapy

CTVClinical target volume

PTVPlanning target volume

MKIMitosis-karyorrhexis index

INPCInternational Neuroblastoma Pathology Committee

IMRTIntensity modulated radiation therapy.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-8-142 contains supplementary material, which is available to authorized users.

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Author: Yoshiko Oshiro - Masashi Mizumoto - Toshiyuki Okumura - Shinji Sugahara - Takashi Fukushima - Hitoshi Ishikawa - Tomohei Na


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