Before the advent of multiagent chemotherapy, the prognosis for patients with Stage IV neuroblastoma of all ages was dismal. More recently, marked improvement in infants with Stage IV neuroblastoma has been reported. Twentyfour infants with Stage IV neuroblastoma have been treated at the Dana-Farber Cancer Institute/The Children's Hospital, and the Joint Center For Radiation Therapy, Boston, Massachusetts, between 1970 and 1988. Twenty-three of these patients were treated with multiagent chemotherapy and one with a single drug. In the initial report, ten of 11 patients were alive without evidence of disease after intensive therapy. In this report the authors update their initial series of patients and include 13 additional patients who subsequently presented to our institutions with Stage IV neuroblastoma younger than 1 year of age. The 5-year actuarial event-free survival for the 24 patients is 75%. No patient without bone metastases died from neuroblastoma, and 12 of 16 patients with bone metastases remained disease free. These results confirm that infants with Stage IV neuroblastoma have a very good prognosis when treated with intensive multiagent chemotherapy. Cancer 67:1493-1497,1991.
HE OUTCOME for patients with Stage IV neuroblas-
T toma presenting at any age was dismal before 1970, with long-term survival usually less than 1 5%.'*2 However, in 1984, Jereb and co-workers noticed an improvement in outcome for infants with Stage IV neuroblastoma compared with older patients: five of 29 (18%) infants with Stage IV neuroblastoma survived compared with zero of 39 children older than age 12 months.' In 1985, Nickerson er af. reported a marked improvement for infants with Stage IV disease, presumably due to the use of intensive multiagent ~hemotherapy.~ In our previous review of 1 1 infants with Stage IV neuroblastoma we also noticed