Localized unresectable neuroblastoma: results of treatment based on clinical prognostic factors
| Autor: | GARAVENTA A, BONI L, LO PICCOLO MS, TONINI GP, GAMBINI C, MANCINI A, TONEGATTI L, CARLI M, DI MONTEZEMOLO LC, DI CATALDO A, MAZZOCCO K, CECCHETTO G, RIZZO A, BERNARDI B, ITALIAN COOPERATIVE GROUP FOR NEUROBLASTOMA, CASALE, Fiorina |
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| Přispěvatelé: | Garaventa, A, Boni, L, LO PICCOLO, M, Tonini, Gp, Gambini, C, Mancini, A, Tonegatti, L, Carli, M, DI MONTEZEMOLO, Lc, DI CATALDO, A, Casale, Fiorina, Mazzocco, K, Cecchetto, G, Rizzo, A, Bernardi, B, ITALIAN COOPERATIVE GROUP FOR, Neuroblastoma |
| Jazyk: | angličtina |
| Rok vydání: | 2002 |
| Předmět: |
Male
Vincristine medicine.medical_specialty Cyclophosphamide medicine.medical_treatment prognostic factors treatment unresectable neuroblastoma Risk Assessment Gastroenterology Drug Administration Schedule Neuroblastoma Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Child Neoadjuvant therapy Survival analysis Neoplasm Staging Proportional Hazards Models Retrospective Studies Chemotherapy Univariate analysis Dose-Response Relationship Drug business.industry Biopsy Needle Infant Newborn Infant Retrospective cohort study Hematology Prognosis medicine.disease Survival Analysis Neoadjuvant Therapy Surgery Treatment Outcome Oncology Doxorubicin Child Preschool Female business medicine.drug |
| Popis: | Background We previously reported that stage 3 neuroblastoma comprises (i) a low-risk group including all infants (age 0–11 months) as well as older children with non-abdominal primaries, and (ii) a high-risk group made up of children >1 year of age with abdominal primaries. Aggressive chemotherapy was effective only in the latter group. Patients and treatment On this basis, in 1990 we designed a new protocol by which all low-risk patients received standard-dose chemotherapy, while the high-risk ones received very aggressive chemotherapy. Results Between November 1990 and December 1997 a total of 95 eligible and evaluable children were enrolled: 47 were low-risk (35 infants and 12 >1 year of age at diagnosis and having non-abdominal primaries), and 48 were high-risk (being >1 year of age and having abdominal primaries). Of the 47 low-risk patients, five relapsed and four subsequently died. The 5-year overall survival (OS) was 91%. Of the 48 patients in the high-risk group, 22 relapsed or progressed, 18 of whom died from their disease and two from toxicity, and one was lost to follow-up. The 5-year OS was 60%. Univariate analysis showed that age, site of primary, risk-group, urine vanillylmandelic excretion, plasma levels of lactate dehydrogenase, ferritin and neurone-specific enolase, and MYCN status correlated with outcome. However, multivariate analysis showed that only MYCN status retained prognostic value. Conclusions In low-risk stage 3 neuroblastoma, standard-dose chemotherapy is associated with an excellent chance of being cured. Aggressive chemotherapy is effective for high-risk patients, but results are still unsatisfactory. MYCN gene amplification is a prognostic indicator for most, but not all, treatment failures. |
| Databáze: | OpenAIRE |
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