A trial looking at intensity modulated arc therapy for neuroblastoma (IMAT)

Cancer type:

Children's cancers

Neuroblastoma

Status:

Results

Phase:

Phase 1/2

This trial compared the standard dose of radiotherapy with a higher dose for people with neuroblastoma. With the standard, older, type of radiotherapy it is difficult to treat the neuroblastoma adequately. While at the same time avoiding too much radiation to important organs.

This study aimed to find out if a new type of radiotherapy called intensity modulated arc therapy would allow the increased dose to be given safely to patients. This is when compared with the older type of radiotherapy.

This trial was for children older than 18 months as well as adults.

It was open for people to join between 2017 and 2020. The team published the results in 2024.

More about this trial

Neuroblastoma is a cancer that usually starts in nerve cells of the tummy (abdomen). It mainly affects children and young people but it can also affect adults.

One of the main treatments for high risk neuroblastoma is radiotherapy. Doctors plan radiotherapy treatment so that cancer cells get a high dose of radiation and healthy cells get a lower dose. But this can sometimes be hard to do using conventional radiotherapy. So researchers decided to investigate a type of radiotherapy called intensity modulated arc therapy (IMAT). It was a new type of radiotherapy when this trial was done. It is more reliable at targeting the cancer than the older standard techniques.

Doctors thought that IMAT could mean a higher dose of radiotherapy can be given so the treatment might be better at killing the cancer cells.

In this trial people had either:

the standard dose of radiotherapy or
a higher dose of radiotherapy

The plan was that people would have their radiotherapy in the usual way or using the IMAT technique. Before treatment, radiotherapy plans using both old and new techniques were prepared. The most suitable one for each person was selected.

The main aims of this trial were to:

find the highest and safest dose of IMAT
find out how well IMAT works
learn more about the side effects of IMAT

Summary of results

Trial design
This was a phase 2 trial. 50 people took part.

It was a randomised trial. A computer put people into a treatment group. There were 2 groups:

25 people had 14 radiotherapy treatments. They had a total dose of 21 Gray . This was the standard dose.
25 people had 24 radiotherapy treatments. They had a total dose of 36 Gray. This was the higher dose.

Doctors chose the plan that offered the best balance between:

targeting the cancer and
causing least damage to the healthy tissues

Results
In this trial, everyone had the IMAT radiotherapy technique. 48 people completed treatment.

The team looked at:

whether the IMAT technique delivered the dose of radiotherapy more accurately to the cancer and
if the normal healthy organs received a much lower dose of radiotherapy

The results showed that the IMAT technique worked better than the old standard technique to:

give the intended dose of radiotherapy to the neuroblastoma and
avoid giving too much radiotherapy to normal healthy organs

Side effects
The team looked at the side effects for everyone who took part in the trial. Most people had at least one side effect. Some of these were mild or didn’t last long.

The team plan to look at the long term side effects. We hope to add these when they become available.

Conclusion
The team concluded that it was possible to give a higher dose of radiotherapy using IMAT. And that the higher dose didn’t affect the surrounding healthy tissue too much. This higher dose was 36 Gy.

IMAT has now become the standard of care technique for people who have high risk neuroblastoma.

The SIOPEN trial is a larger trial that is comparing 21.6 Gy of radiotherapy with 36Gy for neuroblastoma. We have a summary of SIOPEN on our trials database.

More detailed information
There is more information about this research in the reference below.

Please note, this article is not in plain English. It has been written for healthcare professionals and researchers.

A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma.
J Gains and others
Clinical Oncology, 2024. Volume 36, Issue 6: e154-e162

Where this information comes from
We have based this summary on the information in the article above. This has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the link we list above is active and the article is free and available to view.