High‐dose chemotherapy followed by locoregional irradiation improves the outcome of patients with international neuroblastoma staging system Stage II and III neuroblastoma with MYCN amplification

Abstract

BACKGROUNDThe objective of this study was to determine whether systemic and regional, intensified treatment can improve the outcome of children who present with a localized neuroblastoma (NB) with MYCN amplification (MNA).METHODSBetween 1990 and 2000, 610 children with localized NB were included in the Localized Neuroblastoma 90 (NBL 90) and NBL 94 study from the French Society of Pediatric Oncology. Among them, 32 children had MNA with Stage II or III NB. During the first period of the study, 20 children (Group A) received postoperative conventional chemotherapy (CT) and/or radiotherapy (RT), depending on each patient's postoperative status. Subsequently, because of a high recurrence rate, the next 12 children (Group B) were given postoperative high‐dose CT (HDC) (busulfan and melphalan) with stem cell rescue (SCR) followed by RT in addition to conventional postoperative CT.RESULTSThe two groups were comparable with regard to prognostic factors (age, location of the primary lesion, International Neuroblastoma Staging System stage, lymph node invasion) and response to preoperative CT. The 6‐year overall survivalrate was significantly different between the two groups 25% ± 10% in Group A vs. 83% ± 11% in Group B; P = 0.004).CONCLUSIONSPostoperative intensification treatment with HDC, SCR, and locoregional RT resulted in higher survival rates when compared with standard treatment alone and should be considered in the treatment plan for children who are diagnosed with Stage II or III NB and MYCN amplification. Cancer 2004. © 2004 American Cancer Society.

Intensified External-Beam Radiation Therapy Improves the Outcome of Stage 4 Neuroblastoma in Children > 1 Year with Residual Local Disease

“…Other literature reports do not allow a comparison between patients who underwent EBRT and those who did not [5,19]. Some reports on localized neuroblastoma emphasize the particular value of EBRT in MYCN-amplified disease [20,25]. Our analysis cannot contribute to this discussion, since only one patient undergoing EBRT had MYCN amplification.…”

Expression of p53, or targeting towards EGFR, enhances the oncolytic potency of conditionally replicative adenovirus against neuroblastoma

“…Despite intense chemo-radiotherapy supported with autologous stem cell rescue, 60-70% of high-risk NB patients develop recurrent disease that is refractory to additional therapy [3]. These tumors demand an intensified systemic, but also loco-regional treatment for significantly improved outcome [4]. Mutations of p53 are seen in only 2% of neuroblastoma examined [5][6][7][8][9][10], with most p53 mutations observed in tumors coming from patients with progressive or relapsing disease [5][6][7].…”

Response of neuroblastoma cells to ionizing radiation: Modulation of in vitro invasiveness and angiogenesis of human microvascular endothelial cells

“…The prognosis of neuroblastoma is multifactorial and depends on an assortment of clinical and biological factors. Radiotherapy remains an important form of local and regional cancer therapy (3,4). Typical cellular changes resulting from radiation depend on the dose level and time elapsed after exposure.…”