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Neuroblastoma: therapy for infants with good prognosis
Insights
This study shows that low-dose chemotherapy and surgery can effectively treat infant neuroblastoma, achieving high cure rates with minimal side effects. Intensive chemotherapy was not required for a favorable prognosis.
Area of Science:
- Pediatric Oncology
- Cancer Therapeutics
Background:
- Neuroblastoma is a common childhood cancer.
- Favorable prognosis neuroblastoma requires effective treatment with minimal toxicity.
Purpose of the Study:
- To evaluate a therapeutic strategy for infants with favorable prognosis neuroblastoma.
- To achieve high cure rates and prevent serious side effects.
Main Methods:
- Treatment involved surgery alone or combined with low-dose chemotherapy (cytoxan and vincristine) for 1 year.
- Radiation therapy was used for unresected dumbbell tumors.
- Eleven infants younger than one year old were included.
Main Results:
- All infants are alive with no evidence of disease, except one who died in an accident.
- Low-dose chemotherapy prevented recurrences in two infants.
- Chemotherapy reduced residual tumor masses in five infants, with two subsequently removed.
- Three infants with recurrent tumors were successfully treated with surgery or radiation.
- Two infants not receiving chemotherapy after surgery remained disease-free.
Conclusions:
- High cure rates for infant neuroblastoma with favorable prognosis can be achieved without intensive chemotherapy.
- A tailored therapeutic approach combining surgery, low-dose chemotherapy, and radiation is effective.
- Minimizing chemotherapy reduces potential long-term side effects in young children.
Abstract:
Therapy was designed to achieve a high cure rate and to prevent serious therapeutic side effects for 11 infants younger than one year old with neuroblastoma who had a favorable prognosis (Evans Stages I, II, III, and IV-S). It consisted of surgery alone if the tumor was totally removed (one infant) and of surgery and low doses of cytoxan and vincristine for a period of 1 year if the tumor was incompletely removed (seven infants). In addition, radiation therapy was applied to unresected dumbbell tumors (three infants). All infants are alive without evidence of disease with the exception of one who died in an accident. The follow-up time varies from 2-8 years. The drug combination prevented recurrences in two infants whose tumor was reduced by surgery to less than 10% of the original size. In five infants, chemotherapy reduced the size of large residual tumor masses. Two of these masses were subsequently removed. The tumors of the three other infants recurred while on chemotherapy and were successfully eradicated by surgery or radiation therapy. Two infants were not treated according to this therapeutic plan. Although they had small residual masses after surgery, no chemotherapy was given. They are alive without recurrence of the disease 2 years or more after diagnosis. In summary, cure was achieved in these infants without intensive chemotherapy.