Precise delineation of the role of radiotherapy in the treatment of neuroblastoma is hampered by the paucity of studies that evaluate radiation in a prospective, randomized fashion. Data from decades-old retrospective studies are currently used to guide radiation practices. Nevertheless, new studies, although preliminary, may provide insights into the optimal use of radiation therapy in a risk-based treatment approach of this disease.

Historically, radiation therapy was administered to the vast majority of neuroblastoma patients, with the exception of stage-I tumors (Evans 1980). The dose of radiation ranged from 10 to 45 Gy according to patient age rather than stage of disease (Evans et al. 1984). During that era in which patients with early-stage disease received radiation, two studies examined the radiation dose of neuroblastoma (Jacobson et al. 1983, 1984). Doses below 20 Gy were deemed sufficient to achieve local control; however, the majority of patients included in both studies would likely not receive radiation therapy today. Nonetheless, the adequacy of <20 Gy dose was widely adopted for all stages of disease; thus, this dose of radiation that has become the gold standard for high-risk disease was derived from patients now known not to require radiation.

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