title: Did salvage ICE chemotherapy improve the outcome in primary resistant/relapsing stage III/IV neuroblastoma?
abstract: OBJECTIVE
  Neuroblastoma is the most common extracranial and deadly solid tumor in children. It accounts for 15% of the deaths from cancer in the pediatric age group. Approximately half of the newly diagnosed children are at "high risk" of treatment failure. The aim of this study is to evaluate the response rate of salvage chemotherapy by the ICE (Ifosfamide, Carboplatin, and Etoposide) regimen when administered to previously treated primary refractory or progressive high risk neuroblastoma patients.
  
  
  METHODS
  Sixty-six patients from the National Cancer Institute (NCI), Cairo University and the Children Cancer Hospital Egypt (CCHE) received salvage chemotherapy (ICE) either due to primary resistance in 51/66 (77.2%) or due to disease progression on primary chemotherapy in 15/66 (22.8%).
  
  
  RESULTS
  They were 40 males (60.6%) and 26 females (39.4%). Patients' age ranged between 3 months and 12.5 years. The most common tumor site was suprarenal, followed by retroperitoneal mass. Two patients (3%) died from chemotherapy toxicity during ICE administration. Evaluation of tumor response in the remaining 64 patients showed the following: CR/PR in 24 patients (36.5%), SD in 11 patients (16.6%), and PD in 29 patients (43.9%). Fourteen patients (21.2%) were considered eligible for auto BMT, while 50/64 patients (78.8%) failed this second line (salvage) chemotherapy and had palliative lines of therapy. By the end of the study (May 2010), 47/66 (71.2%) of the patients were still alive, while 19/66 (28.8%) were dead. Two out of 14 patients (14.2%) who underwent HSCT died from post transplantation disease progression, while 12/14 (85.8%) were in CCR.
  
  
  CONCLUSIONS
  Chemotherapy by ICE for primary resistant or progressive stage III/IV NB seems well tolerated. With a 36.6% response rate, 18% CCR, and 3% treatment mortality rate, it could be considered a good salvage therapy in the category of patients who are condemned for palliation.
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University and Children Cancer Hospital Egypt (CCHE), Cairo, Egypt. hanyrahman@hotmail.com
authors.forename: Hany
authors.initials: H
authors.lastname: Abdel Rahman
authors.forename: Emad A H
authors.initials: EA
authors.lastname: Moussa
authors.forename: Wael Z K
authors.initials: WZ
authors.lastname: Zekri
authors.forename: Eman
authors.initials: E
authors.lastname: El Debawy
authors.forename: Naglaa E
authors.initials: NE
authors.lastname: Mostafa
authors.forename: Alaa
authors.initials: A
authors.lastname: Yones
authors.forename: Sameera
authors.initials: S
authors.lastname: Ezzat
authors.forename: Abd El Rahman
authors.initials: Ael R
authors.lastname: Rayan
mesh_terms: D000008:Abdominal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D009447:Neuroblastoma / Q000188:drug therapy* / Q000401:mortality; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide