title: LMCE3 treatment strategy: results in 99 consecutively diagnosed stage 4 neuroblastomas in children older than 1 year at diagnosis.
abstract: OBJECTIVE
  To tailor postinduction therapy for stage 4 neuroblastoma in children who are older than 1 year at diagnosis according to status after induction.
  
  
  METHODS
  From March 1987 to December 1992, 99 patients who were consecutively admitted were included in the Lyon-Marseille-Curie East of France (LMCE)3 strategy. After induction with the French Society of Pediatric Oncology NB87 regimen and surgery, patients who were in complete remission immediately proceeded to consolidation therapy with vincristine, melphalan, and fractionated total-body irradiation (VMT). All other patients underwent a postinduction strategy before VMT, either an additional megatherapy regimen or further chemotherapy with etoposide/carboplatin.
  
  
  RESULTS
  The progression-free survival (PFS) is 29% at 7 years from diagnosis, which compares favorably with that of a similar cohort of 72 patients previously reported by our group (LMCE1; PFS of 20% at 5 years and 8% at 14 years, P =.004). In the multivariate analysis, only age younger than 3 years at diagnosis (P =.0085) and achievement of complete or very good partial remission after NB87 and surgery (P =.00024) remained significant. The PFS of the 87 patients who were included in the postinduction strategy was significantly better than that of the comparable 62 patients on the LMCE1 study (32% v 11% at 7 years; P =.005).
  
  
  CONCLUSIONS
  The progressive improvements in the LMCE results over the last 10 years suggest that improvements in supportive care measures and increases in each component of this strategy (induction, postinduction, consolidation) may all contribute to increased survival rates.
authors.affiliation: Centre L. Bérard, Lyon, France. frappaz@lyon.fnclcc.fr
authors.forename: D
authors.initials: D
authors.lastname: Frappaz
authors.forename: J
authors.initials: J
authors.lastname: Michon
authors.forename: C
authors.initials: C
authors.lastname: Coze
authors.forename: C
authors.initials: C
authors.lastname: Berger
authors.forename: E
authors.initials: E
authors.lastname: Plouvier
authors.forename: C
authors.initials: C
authors.lastname: Lasset
authors.forename: J L
authors.initials: JL
authors.lastname: Bernard
authors.forename: J L
authors.initials: JL
authors.lastname: Stephan
authors.forename: E
authors.initials: E
authors.lastname: Bouffet
authors.forename: M
authors.initials: M
authors.lastname: Buclon
authors.forename: V
authors.initials: V
authors.lastname: Combaret
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: T
authors.initials: T
authors.lastname: Philip
authors.forename: J M
authors.initials: JM
authors.lastname: Zucker
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009447:Neuroblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D013899:Thoracic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D014916:Whole-Body Irradiation