[Treatment of advanced neuroblastoma with regimens containing cis-dichlorodiammineplatinum--effect and toxicity]

Ten children with advanced neuroblastoma were treated with regimens containing cis-dichlorodiammineplatinum (CDDP-regimens). Six cases had been refractory or had evidenced inadequate response to previous chemotherapy consisting of cyclophosphamide and adriamycin or vincristine, and radiotherapy. Clinical response was evaluable for 9 cases. Complete response was obtained in 2 cases, partial response in 2 cases, minor response in 2 cases, no change in 1 case and progressive disease in 2 cases. Six of these 9 cases had 2nd look surgery after several CDDP-regimens. Complete resection of tumor was possible in 1 case, subtotal resection in 4 cases and partial resection in 1 case. In an additional case whose clinical response was impossible because of absence of palpable tumor, the tumor had completely disappeared by the time of surgery. Three cases have survived for 5 months, 5 months and 28 months respectively without clinical evidence of tumor, 2 cases for 9 months and 12 months, respectively, with tumor. Four cases died of progressive tumor growth at 9 months, 10 months, 10 months, and 59 months, respectively. One case died of pneumonia at 10 months without clinical evidence of tumor. These results are far better than in our previous experience. Nephrotoxicity was observed in all cases, but it was tolerable in all cases including 3 heminephrectomized children. Hypomagnesemic, hypocalemic tetany was observed in 1 case. This complication was ameliorated by administration of magnesium gluconate. Mean +/- standard deviation of the lowest serum concentration of calcium and magnesium during this medication was 9.75 +/- 0.76 mg/dl and 1.39 +/- 0.44 mg/dl, respectively, against 7.56 +/- 1.64 mg/dl and 0.90 +/- 0.29 mg/dl without the medication, respectively. CDDP is concluded to be against neuroblastoma and its toxicity is tolerable. Magnesium gluconate administration is essential for prevention of tetany.