Neuroblastoma in adolescents and adults: The Memorial Sloan-Kettering experience Journal Article
| Authors: | Kushner, B. H.; Kramer, K.; LaQuaglia, M. P.; Modak, S.; Cheung, N. K. V. |
| Article Title: | Neuroblastoma in adolescents and adults: The Memorial Sloan-Kettering experience |
| 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-GD2 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-GD2 antibodies, and cis-retinoic acid, may improve the poor prognosis of these patients reported to date. © 2003 Wiley-Liss, Inc. |
| Keywords: | adolescent; adult; cancer chemotherapy; cancer survival; child; clinical article; treatment outcome; disease-free survival; unclassified drug; busulfan; fludarabine; cancer recurrence; salvage therapy; cisplatin; doxorubicin; fluorouracil; drug efficacy; cancer radiotherapy; combined modality therapy; chemotherapy; methotrexate; topotecan; drug megadose; follow-up studies; carboplatin; dacarbazine; cancer immunotherapy; low drug dose; sensory neuropathy; etoposide; thrombocytopenia; antineoplastic combined chemotherapy protocols; radiotherapy; granulocyte macrophage colony stimulating factor; cyclophosphamide; melphalan; vincristine; ifosfamide; thiotepa; monoclonal antibody; febrile neutropenia; hypotension; cancer regression; immunotherapy; neuroblastoma; radiation dose fractionation; drug response; dactinomycin; retinoic acid; arylbutyric acid derivative; adult disease; bone marrow purging; ganglioside antibody; adolescents; preleukemia; myeloablative agent; stomach paresis; humans; prognosis; human; male; female; priority journal; article; cis retinoic acid; monoclonant antibody 3f8; adolescent disease |
| Journal Title: | Medical and Pediatric Oncology |
| Volume: | 41 |
| Issue: | 6 |
| ISSN: | 0098-1532 |
| Publisher: | Wiley Liss |
| Date Published: | 2003-12-01 |
| Start Page: | 508 |
| End Page: | 515 |
| Language: | English |
| DOI: | 10.1002/mpo.10273 |
| PUBMED: | 14595707 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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650Cheung -
236Kramer -
249Modak
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