title: Results of pediatric oncology group protocol 8104 for infants with stages D and DS neuroblastoma.
abstract: OBJECTIVE
  We determined the complete response and survival rates for infants with disseminated (stage D) neuroblastoma that followed therapy identical to that for regional disease. In those infants whose disease excluded cortical bone metastases (stage DS), we determined complete response rates achieved either spontaneously or with stage D therapy.
  
  
  METHODS
  Eighty-eight patients with metastatic disease received induction chemotherapy followed by a second operation, the results of which determined additional therapy. Twenty-five patients were observed after diagnosis, without chemotherapy, until a second operation.
  
  
  RESULTS
  The complete response (CR) rates for patients with stage D disease after induction chemotherapy and postinduction surgery were 26% and 52%, respectively, and for immediately treated patients with stage DS disease 69% and 77%, respectively. Fifty-four percent of initially observed patients with stage DS disease achieved CR after a second operation; 44% were never treated beyond these two operations. Five-year actuarial survival rates for patients with stage D and for all those with stage DS disease were 60% (SE = 6%) and 90% (SE = 5%), respectively.
  
  
  CONCLUSIONS
  Improved survival rates for patients with stage D disease were achieved on this protocol but remained considerably lower than those for infants with less extensive disease. Rates of survival for patients with stage DS disease were achieved with therapy less aggressive than in published series.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
authors.forename: D
authors.initials: D
authors.lastname: Strother
authors.forename: J J
authors.initials: JJ
authors.lastname: Shuster
authors.forename: N
authors.initials: N
authors.lastname: McWilliams
authors.forename: R
authors.initials: R
authors.lastname: Nitschke
authors.forename: E I
authors.initials: EI
authors.lastname: Smith
authors.forename: V J
authors.initials: VJ
authors.lastname: Joshi
authors.forename: L
authors.initials: L
authors.lastname: Kun
authors.forename: F A
authors.initials: FA
authors.lastname: Hayes
authors.forename: R
authors.initials: R
authors.lastname: Castleberry
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis