Impact of radiotherapy on survival outcomes in metastatic neuroblastoma a propensity score matched SEER database analysis

Metastatic neuroblastoma is a highly aggressive pediatric malignancy with poor prognosis. Radiotherapy is commonly used as part of multimodal treatment, but its impact on survival outcomes remains controversial. This study investigates the association between radiotherapy and survival in patients with metastatic neuroblastoma using data from the Surveillance, Epidemiology, and End Results (SEER) database. A retrospective analysis was conducted on 4,850 patients diagnosed with metastatic neuroblastoma from the SEER database (2004-2015). After applying exclusion criteria, 981 patients were included, with 368 receiving radiotherapy. Propensity score matching (PSM) was used to balance baseline characteristics between the radiotherapy and non-radiotherapy groups, resulting in 234 patients in each group. Survival outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazards models. Before PSM, no significant difference in overall survival (OS) and cancer-specific survival (CSS) was observed between patients who received radiotherapy and those who did not. After PSM, there was a trend toward improved OS and CSS in the radiotherapy group, though statistical significance was not reached. Cox regression analysis identified age ≥ 1 year and non-adrenal primary tumor site as significant independent predictors of poorer OS and CSS. Radiotherapy was not an independent predictor of survival in the multivariate analysis, but a trend toward a survival benefit was noted, particularly in patients with larger tumors and those who underwent surgery. Radiotherapy may improve survival in metastatic neuroblastoma patients with large tumors or surgical resection, though its independent benefit remains uncertain. Personalized strategies require integrating updated COG risk stratification with biomarkers and prospective trials assessing long-term outcomes to refine treatment approaches.