Radiation Therapy Outcomes of the National Protocol in Childhood Neuroblastomas: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology, and TBI Working Group Study (TROD 03-004).
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PURPOSE: The Turkish Pediatric Oncology Group (TPOG) established a risk-adapted national neuroblastoma (NBL) treatment strategy in 2003 and updated it in 2009 and 2020 to optimize outcomes in NBL. With this study, we aimed to evaluate the oncological outcomes of our national protocol with a special emphasis on local control. METHODS AND MATERIALS: We retrospectively evaluated 135 NBL patients who received adjuvant radiation therapy between May 2004 and May 2018 from 7 tertiary pediatric oncology centers in Türkiye. Patients were treated according to TPOG-NBL2003 and TPOG-NBL2009 protocols. All statistical analyses were performed using SPSS 23.0 software (SPSS). RESULTS: The median age was 42 months, and 58 (43%) patients were female. The adrenal medulla was the primary tumor location in 103 (76%) patients. Only 14 patients had intermediate-risk disease, whereas 121 had high-risk disease. The median follow-up was 67.3 months. The 2- and 5-year overall survival (OS) rates were 84% and 68%, locoregional recurrence-free survival (LRRFS) rates were 81% and 66%, distant metastasis-free survival rates were 76% and 56%, and event-free survival (EFS) rates were 74% and 54%, respectively. The International Neuroblastoma Staging System stage was a significant predictor of OS, while the International Neuroblastoma Staging System stage and lactate dehydrogenase level at diagnosis predicted EFS, and the lactate dehydrogenase level at diagnosis predicted LRRFS. There were no differences in OS, EFS, or LRRFS based on radiation therapy doses. CONCLUSIONS: In this study, we evaluated the outcomes of our TPOG-NBL2003 and TPOG-NBL2009 protocols. Our survival outcomes are consistent with the current literature, which emphasizes the importance of establishing a national protocol. Effective NBL treatment necessitates a multidisciplinary approach, and standardization of treatment should be accomplished through protocols.