title: Outcome of high-risk neuroblastoma using a dose intensity approach: improvement in initial but not in long-term results.
abstract: BACKGROUND
  Stage 4 and MYCN amplified (MNA) neuroblastoma in children have a poor prognosis. Our aim was to increase initial and long-term response in this population.
  
  
  METHODS
  High-risk children were studied according to the International Neuroblastoma Staging System, then treated with high-dose cyclophosphamide and high-dose carboplatin, followed by surgery and autologous stem cell transplant or maintenance chemotherapy.
  
  
  RESULTS
  From June 1992 to December 1998, 83 children were admitted in the study (72 stage 4> 1 year, 5 stage 4 MNA infants, and 6 MNA stage 3 children); tumor tissue was obtained from 73, MYCN was performed in 65, being amplified in 21 (32%). Induction chemotherapy was administered in the expected time in 35% of patients. Its toxicity was mainly hematologic followed by infections, and there were 3 chemotherapy-related deaths. Delayed surgery was performed on 60 patients with complete or >90% resection in 80% of cases. Chemotherapy plus surgery produced some response in 90% of patients, 53% were in CR/VGPR; 49 children received autologous SCT, and 16 received maintenance chemotherapy for 9 months. Follow-up ranges are 1-87 months, mean 30 months. S and EFS at 4 years are 0.33 (SD 0.02).
  
  
  CONCLUSIONS
  High-dose cyclophosphamide and high-dose carboplatin are effective in the initial treatment of neuroblastoma; combined with surgery they produce some response in most patients. Nevertheless, the CR/VGPR rate reaches only 53%. Survival time has also been prolonged but most patients relapse with metastases.
authors.affiliation: Neuroblastoma Group, Spanish Society of Pediatric Oncology, Valencia, Spain. castel_vic@gva.es
authors.forename: V
authors.initials: V
authors.lastname: Castel
authors.forename: A
authors.initials: A
authors.lastname: Cañete
authors.forename: S
authors.initials: S
authors.lastname: Navarro
authors.forename: P
authors.initials: P
authors.lastname: García-Miguel
authors.forename: C
authors.initials: C
authors.lastname: Melero
authors.forename: T
authors.initials: T
authors.lastname: Acha
authors.forename: A
authors.initials: A
authors.lastname: Navajas
authors.forename: M D
authors.initials: MD
authors.lastname: Badal
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D013030:Spain; D016019:Survival Analysis; D017741:Survivors; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D016190:Carboplatin