In the management of the primary site in high risk neuroblastoma, is there a role for a cone-down to residual disease (boost), following treatment of the post-chemo, pre-surgical extent to 21.6 Gy?

Patients who were enrolled in ANBL 0532 who received a 14.4 Gy boost to the primary site were compared with patients who received no boost enrolled on COG A3973. Five year CILP (cumulative incidence of local progression), EFS, and OS were the same between the two groups of patients. This was presented as an oral scientific session at the ASTRO 2019 annual meeting. After this data was reported, the current ANBL 1531 COG protocol was amended to remove the boost to the primary site of disease. 

Boost is no longer recommended.