Management and outcome of stage 3 neuroblastoma Journal Article


Authors: Modak, S.; Kushner, B. H.; LaQuaglia, M. P.; Kramer, K.; Cheung, N. K. V.
Article Title: Management and outcome of stage 3 neuroblastoma
Abstract: Purpose: The management of patients with International Neuroblastoma Staging System (INSS) stage 3 neuroblastoma (NB) is not consistent worldwide. We describe a single centre approach at Memorial Sloan-Kettering Cancer Centre (MSKCC) from 1991 to 2007 that minimises therapy except for those patients with MYCN-amplified NB. Methods: In this retrospective analysis of 69 patients, tumour MYCN was not amplified in 53 and amplified in 16. Event-free survival (EFS) and overall survival (OS) were determined by Kaplan-Meier analysis. Results: Fourteen patients with non-MYCN-amplified tumours were treated with surgery alone (group A) and the remaining 39 (group B) with surgery following chemotherapy that was initiated and administered at non-MSKCC institutions. Chemotherapy was discontinued after surgery in 38/39 of the latter. The 10-year EFS and OS for all patients with MYCN-non-amplified NB were 74.9 ± 16.9% and 92.6 ± 5.5%, respectively. There was no difference in OS between groups A and B (p = 0.2; 10-year OS for groups A and B was 84.6 ± 14% and 97.1 ± 2.9%, respectively). Patients with MYCN-amplified disease (group C) underwent dose-intensive induction, tumour resection and local radiotherapy: 13 achieved complete or very good partial remission, and 10 received myeloablative chemotherapy. 11/16 patients also received 3F8-based immunotherapy: 10 remain free of disease. The 10-year EFS and OS for patients with MYCN-amplified neuroblastoma treated with immunotherapy were both 90.9 ± 8.7%. Conclusion: Patients with MYCN-non-amplified stage 3 NB can be successfully treated with surgery without the need for radiotherapy or continuation of chemotherapy. Combination of dose-intensive chemotherapy, surgery, radiotherapy and immunotherapy was associated with a favourable outcome for most patients with MYCN-amplified stage 3 NB. © 2008 Elsevier Ltd. All rights reserved.
Keywords: cancer chemotherapy; cancer survival; controlled study; treatment outcome; disease-free survival; survival rate; retrospective studies; major clinical study; antineoplastic agents; cancer radiotherapy; combined modality therapy; cancer staging; antineoplastic agent; neoplasm staging; cancer immunotherapy; gene amplification; nuclear proteins; kaplan-meiers estimate; patient care; immunotherapy; infant; infant, newborn; neuroblastoma; oncogene proteins; remission; stage 3 neuroblastoma
Journal Title: European Journal of Cancer
Volume: 45
Issue: 1
ISSN: 0959-8049
Publisher: Elsevier Inc.  
Date Published: 2009-01-01
Start Page: 90
End Page: 98
Language: English
DOI: 10.1016/j.ejca.2008.09.016
PUBMED: 18996003
PROVIDER: scopus
PMCID: PMC3727624
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 30 November 2010" - "CODEN: EJCAE" - "Source: Scopus"
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MSK Authors
  1. Brian Kushner
    190 Kushner
  2. Nai-Kong Cheung
    439 Cheung
  3. Kim Kramer
    168 Kramer
  4. Shakeel Modak
    159 Modak