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Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment.

Luksch R, Podda M, Gandola L, Polastri D, Piva L, Castellani R, Collini P, Massimino M, Cefalo G, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Bozzi F, Marchianò A, Ravagnani F, Fossati-Bellani F - Br. J. Cancer (2005)

Bottom Line: Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03).This finding led us to conclude that sequential HBI is useless as consolidation treatment.The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted.

View Article: PubMed Central - PubMed

Affiliation: Unità di Pediatria, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy. roberto.luksch@istitutotumori.mi.it

ABSTRACT
The aim of the present study was to evaluate the effectiveness of two consecutive nonrandomised treatment programs applied between 1989 and 1999 at the Istituto Nazionale Tumori of Milan in an unselected cohort of 59 children over the age of one with stage 4 neuroblastoma. Both treatment programs consisted of two phases, the induction of the remission phase and the consolidation phase. The induction of the remission phase consisted of intensive chemotherapy, and remained the same throughout the study period. The consolidation phase consisted of sequential hemi-body irradiation (HBI) (10 Gy per session, 6 weeks apart) in the first period (1988-June 1994) and sequential high-dose cyclophosphamide, etoposide, mitoxantrone+L-PAM and autologous haemopoietic stem cell transplantation in the second (July 1994-1999). Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03). This finding led us to conclude that sequential HBI is useless as consolidation treatment. The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted.

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Survival by treatment program.
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fig2: Survival by treatment program.

Mentions: Among the patients who concluded the treatment program, 31 relapsed a median 16 months after diagnosis (range 9–66). The relapse pattern was: metastatic spread, 21 (68%); metastatic spread plus local relapse, eight (26%); isolated local relapse, two (6%). None of the patients with nonresponse or progression of disease survived after second-line therapy. In all, 46 out of 59 patients died (22 in program-1 and 24 in program-2). The median follow-up for the entire series at the time of the current analysis (as at June 2004) was 62 months (range 51–164). The 5-year EFS and 5-year S probability for the entire series was 0.18 and 0.25, respectively (Figure 1). Analysing the outcome according to the treatment program adopted revealed a significant difference between the two: the 5-year EFS probability was 0.12 for program-1 and 0.31 for program-2 (P=0.03); the 5-year S probability was 0.12 for program-1 and 0.35 for program-2 (P=0.03) (Figure 2).


Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment.

Luksch R, Podda M, Gandola L, Polastri D, Piva L, Castellani R, Collini P, Massimino M, Cefalo G, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Bozzi F, Marchianò A, Ravagnani F, Fossati-Bellani F - Br. J. Cancer (2005)

Survival by treatment program.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361794&req=5

fig2: Survival by treatment program.
Mentions: Among the patients who concluded the treatment program, 31 relapsed a median 16 months after diagnosis (range 9–66). The relapse pattern was: metastatic spread, 21 (68%); metastatic spread plus local relapse, eight (26%); isolated local relapse, two (6%). None of the patients with nonresponse or progression of disease survived after second-line therapy. In all, 46 out of 59 patients died (22 in program-1 and 24 in program-2). The median follow-up for the entire series at the time of the current analysis (as at June 2004) was 62 months (range 51–164). The 5-year EFS and 5-year S probability for the entire series was 0.18 and 0.25, respectively (Figure 1). Analysing the outcome according to the treatment program adopted revealed a significant difference between the two: the 5-year EFS probability was 0.12 for program-1 and 0.31 for program-2 (P=0.03); the 5-year S probability was 0.12 for program-1 and 0.35 for program-2 (P=0.03) (Figure 2).

Bottom Line: Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03).This finding led us to conclude that sequential HBI is useless as consolidation treatment.The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted.

View Article: PubMed Central - PubMed

Affiliation: Unità di Pediatria, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy. roberto.luksch@istitutotumori.mi.it

ABSTRACT
The aim of the present study was to evaluate the effectiveness of two consecutive nonrandomised treatment programs applied between 1989 and 1999 at the Istituto Nazionale Tumori of Milan in an unselected cohort of 59 children over the age of one with stage 4 neuroblastoma. Both treatment programs consisted of two phases, the induction of the remission phase and the consolidation phase. The induction of the remission phase consisted of intensive chemotherapy, and remained the same throughout the study period. The consolidation phase consisted of sequential hemi-body irradiation (HBI) (10 Gy per session, 6 weeks apart) in the first period (1988-June 1994) and sequential high-dose cyclophosphamide, etoposide, mitoxantrone+L-PAM and autologous haemopoietic stem cell transplantation in the second (July 1994-1999). Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03). This finding led us to conclude that sequential HBI is useless as consolidation treatment. The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted.

Show MeSH
Related in: MedlinePlus