Abstract
Background
We reviewed the utility of different treatment modalities in a large series of adolescents/adults with neuroblastoma (NB).
Procedure
The 30 adolescents/adults (median age, 19 years) had stage 2B (n = 1), 3 (n = 2), or 4 (n = 27) NB. Treatments included conventional and myeloablative therapy; local radiotherapy (RT); immunotherapy with anti‐G~D2~ 3F8 monoclonal antibody ± granulocyte–macrophage colony‐stimulating factor (GM‐CSF); and 3F8 alternating with low‐dose oral etoposide.
Results
Seven patients are in first (n = 4) or second (n = 3) complete/very good partial remission (CR/VGPR) at 9+ to 181+ (median, 45+) months. Among 13 newly diagnosed or minimally prior‐treated patients, no major responses were seen in 4/4 treated with N4/N5 chemotherapy, but 6/9 treated with the higher dose N6/N7 regimens and surgery had major responses, and immunotherapy produced CR in BM in three patients. Among 17 patients referred because of resistant NB, favorable responses occurred in 6/12 treated with high‐dose cyclophosphamide‐based salvage therapy, including one patient who is in CR 170+ months after myeloablative consolidation and five patients who achieved CR/VGPR after 3F8/GM‐CSF (n = 4) or 3F8/oral etoposide (n = 1). With a median follow‐up of 32+ months post‐RT, no local relapses occurred in 10/10 patients who received hyperfractionated 21 Gy RT to prevent regrowth of soft tissue masses that had been resected.
Conclusions
High‐dose chemotherapy and surgery can achieve a minimal disease state in >50% of newly diagnosed older NB patients. In that setting, local RT, and the use of agents with recently confirmed anti‐NB activity, including anti‐G~D2~ antibodies, and cis‐retinoic acid, may improve the poor prognosis of these patients reported to date. Med Pediatr Oncol 2003;41:508–515. © 2003 Wiley‐Liss, Inc.