Treatment of stage III neuroblastoma with emphasis on intensive induction chemotherapy: a report from the Neuroblastoma Group of the Spanish Society of Pediatric Oncology.
From October 87 to April 92, 172 children were admitted in the N-I-87 protocol of the Spanish Society of Pediatric Oncology for the diagnosis and treatment of neuroblastoma. Forty-eight were considered Evans stage III, 33 of them being older than 1 year. All children were treated with induction chemotherapy (IC) and surgery. IC consisted of three courses of high-dose cisplatin-VM-26 alternating with three further courses of cyclophosphamide-doxorubicin (CAD). Infants less than 1 year received the same drugs at lower doses. After surgery, maintenance chemotherapy was administered to all children during 14 months. It consisted of four pairs of drugs rotated every 4 weeks. Radiotherapy was administered exclusively to patients older than 1 year with residual tumor after IC and surgery. Response was evaluated after IC and surgery. In children older than 1 year, response was obtained in 28/33 (88%). Fifteen of them (47%) achieved complete remission (CR), seven (22%) good partial response (GPR), six (19%) partial response (PR); and in three patients (9%) there was progressive disease (PD). Actuarial survival at 48 months was 0.60 +/- 0.10 and EFS was 0.61 +/- 0.12. Audiologic impairment was considered the worst toxicity. In children less than 1 year the response rate to IC and surgery was 93% (14/15); nine infants obtained complete response and four had GPR. Only one patient experienced PD in the first 6 months of therapy and died. The other 14 are alive and well at a mean follow-up time of 48 months. Chemotherapy toxicity was mild and reversible.
Castel
V
V
Pediatric Hematology/Oncology Unit, University Children's Hospital La Fe, Valencia, Spain.
Badal
M D
MD
Bezanilla
J L
JL
Llombart
A
A
Ruiz-Jiménez
J I
JI
Sánchez de Toledo
J
J
Melero
C
C
Mulet
J
J
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009447:Neuroblastoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D016896:Treatment Outcome; D014751:Vindesine / Q000008:administration & dosage
D008130:Lomustine; D008558:Melphalan; D014751:Vindesine