title: Postoperative treatment of nonmetastatic visible residual neuroblastoma: a Pediatric Oncology Group study.
abstract: The Pediatric Oncology Group (POG) evaluated in a prospective study the hypothesis that patients who had localized, visible residual neuroblastoma without regional lymph node involvement after surgery (POG stage B) have a favorable prognosis when treated with moderate intensive chemotherapy. Eligible patients were initially treated with five courses of Cytoxan (cyclophosphamide; Bristol-Myers Squibb Co., Evansville, IN) and Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) followed by surgery (CY/AD +/- surgery). Those patients not achieving a complete remission (CR) crossed over to five courses of cisplatin and teniposide (PL/VM) +/- surgery. Radiation therapy (XRT) was given to selected patients who still were not in CR after the crossover therapy. Of the 61 eligible patients, 38 (62%) patients achieved CR after CY/AD proven by clinical (31) or surgical (seven) evaluation. One (2%) patient in clinical partial remission (PR-C) entered CR without further therapy. Nineteen (31%) patients achieved CR with the following salvage therapies: surgery (five), PL/VM +/- surgery (five) followed by XRT (three) or autologous bone marrow transplant (ABMT) (one) and further courses of CY/AD +/- PL/VM instead of courses of PL/VM (five). The overall CR rate was 95% (58 of 61). Four patients had recurrence of the disease. The probability of being disease-free at 3 years after initial or salvage therapy was estimated at 84% (SE, 5%). The overall prognosis of children older than 1 year and younger than 1 year was similar (P = .26). If, however, the three remission deaths (all younger than 1 year) were censored, there was only one other failure in 32 children younger than one versus seven of 29 children older than 1 year (P = .018). These results confirm the excellent prognosis for patients with POG stage B neuroblastoma and indicate that most patients are curable with CY/AD +/- surgery, and those not achieving CR with this therapy are curable with alternate therapy.
authors.affiliation: Oklahoma University Health Sciences Center, Oklahoma City.
authors.forename: R
authors.initials: R
authors.lastname: Nitschke
authors.forename: E I
authors.initials: EI
authors.lastname: Smith
authors.forename: G
authors.initials: G
authors.lastname: Altshuler
authors.forename: D
authors.initials: D
authors.lastname: Altmiller
authors.forename: J
authors.initials: J
authors.lastname: Shuster
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.forename: R
authors.initials: R
authors.lastname: Castleberry
authors.forename: F A
authors.initials: FA
authors.lastname: Hayes
authors.forename: B
authors.initials: B
authors.lastname: Golembe
authors.forename: R
authors.initials: R
authors.lastname: Ducos
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide