Improvement in survival after excision of primary tumor in stage III neuroblastoma

Haase, Gerald M.; Wong, Kwan Y.; deLorimier, Alfred A.; Sather, Harland N.; Hammond, G. Denman

doi:10.1016/s0022-3468(89)80248-9

Cited by 77 publications

(25 citation statements)

References 19 publications

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“…As a matter of fact, many of the patients described in these studies experienced disseminated recurrences, as opposed to 4% of metastatic relapses (28% of the relapses) in our series. Second, most authors agree that the degree of surgical excision in localized NB will influence outcome (Evans et al, 1976;Le Tourneau et al, 1985;Haase et al, 1989;Garaventa et al, 1993). Consequently, primary chemotherapy permitting radical surgery, and perhaps also postoperative treatment, may exert a major impact on outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Primary surgery can be performed in about half of these children and reported survival rates are high (De Bernardi et al, 1995). However, unresectable tumours usually have a poorer outcome, unless secondary radical excision can be performed (Rosen et al, 1984b;Haase et al, 1989;Tsuchida et al, 1992). Consequently, the efficacy of primary chemotherapy to allow subsequent resection is of outstanding importance (Garaventa et al, 1993; West et al, 1993).…”

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confidence: 99%

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Unresectable localized neuroblastoma: improved survival after primary chemotherapy including carboplatin-etoposide

Michon¹,

Plantaz²,

Peyroulet³

et al. 1998

Br J Cancer

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Keywords: neuroblastoma; carboplatin; etoposide; N-myc Neuroblastoma (NB) is the most common solid tumour of early childhood (Bernstein et al, 1992). Approximately 50% of patients present with localized tumours (Hartmann et al, 1983;Rosen et al, 1984a) and radical surgical excision is generally considered as the main requirement for cure (Evans et al, 1976; Le Toumeau et al, 1985). Primary surgery can be performed in about half of these children and reported survival rates are high (De Bernardi et al, 1995). However, unresectable tumours usually have a poorer outcome, unless secondary radical excision can be performed (Rosen et al, 1984b;Haase et al, 1989;Tsuchida et al, 1992). Consequently, the efficacy of primary chemotherapy to allow subsequent resection is of outstanding importance (Garaventa et al, 1993; West et al, 1993). We previously reported the efficacy of the combination of carboplatin and etoposide (CE) in refractory or relapsed NBs (Frappaz et al, 1992) and investigated its relevance as a first line therapy in unresectable NBs.In 1990, a national prospective study (NBL 90) was initiated, registering all children with localized NBs diagnosed in the institutions of the French Society of Pediatric Oncology (SFOP). The Primary aim was to assess the efficacy and the safety of such chemotherapy as primary treatment in unresectable NBs, PATIENTS AND METHODS Patient populationUntreated children aged from 0 to 16 years were eligible. The primary tumour was evaluated using computerized tomography (CT)-scan or magnetic resonance imaging (MRI) as well as metaiodobenzylguanidine (MIBG) scintigraphy. Work-up to eliminate metastatic spread included the skeletal study by MIBG (or a 99mTc scan in the absence of MIBG uptake at the primary site), radiograph in infants and extensive bone marrow staging (at least two aspirations and two trephine biopsies). Urinary catecholamines (VMA, HVA and dopamine), serum neuron-specific enolase (NSE), ferritin and lactate dehydrogenase (LDH) levels were measured. The diagnosis of NB was always confirmed by cytological or histological documentation. The primary tumour was staged according to TNM (Beahrs, 1983) and INSS (Brodeur et al, 1993). However, those unresectable NBs did not overlap completely with INSS stage 3 tumours. Indeed, according to our definition of resectability using radiological data, those tumours were not operated first and some of them were INSS stage 2 (i.e. lateral tumours encasing regional organs or vessels and dumbbell tumours). Analysis of the N-myc oncogene (Seeger et al, 1985)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Unresectable localized neuroblastoma: improved survival after primary chemotherapy including carboplatin-etoposide

Michon¹,

Plantaz²,

Peyroulet³

et al. 1998

Br J Cancer

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“…Conversely, unresectable NB often carries a poor prognosis as achieving EFS greater than 50% has proven difficult (Garaventa et al, 1993, West et al, 1993. In that subset of patients, surgical excision is recognised as being a major step for cure (Le Tourneau et al, 1985;Haase et al, 1989;Tsuchida et al, 1989). Consequently, primary chemotherapy allowing resection is of outstanding importance.…”

Section: Discussionmentioning

confidence: 99%

“…Primary surgery can be performed in about 50% of these children and reported survival rates are high (De Bernardi et al, 1995). Conversely, unresectable tumours usually have a poorer outcome, unless secondary radical excision can be performed (Haase et al, 1989, Tsuchida et al, 1989. Consequently, the efficacy of primary chemotherapy in allowing subsequent resection is of outstanding importance (Garaventa et al, 1993;West et al, 1993).…”

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confidence: 99%

Localised and unresectable neuroblastoma in infants: excellent outcome with low-dose primary chemotherapy

Rubie

Coze

Plantaz³

et al. 2003

Br J Cancer

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The purpose of this study was to evaluate the efficacy of low-dose chemotherapy in infants with localised and unresectable neuroblastoma (NB). All consecutive infants with localised NB and no N-myc amplification were eligible in the SFOP-NBL 94 study. Primary tumour was deemed as unresectable according to imaging data showing any risk of immediate resection. Diagnostic procedures and staging were conducted according to INSS recommendations. For children, provided that they had no threatening symptom (i.e. vital risk or dumb-bell NB with neurologic deficit), chemotherapy consisted in low-dose cyclophosphamide (5 mg À1 kg day À1 Â 5 days) and vincristine (0.05 mg kg À1 at day 1) -CV and repeated one to three times every 2 weeks until surgical excision can be safely performed. No postoperative treatment was given. Between January 1995 and December 1999, 134 consecutive infants with localised NB were registered in the study, of whom 39 had an unresectable NB without N-myc amplification. Among them 28 had no threatening symptom and received CV according to the protocol. Objective response was observed in 14 (50%) and the other 14 were given second-line chemotherapy because of no response. Surgery was attempted in 38 patients including 14 after CV alone, leading to complete resection in 23. Relapses occurred in four patients all local. Survival and event-free survival were 100 and 9075% with a median follow-up of 55 months (range 33 -93). In conclusion primary low-dose chemotherapy without anthracyclines is efficient in about half of the infants presenting with an unresectable NB and no N-myc amplification, allowing excellent survival rates without jeopardising their long-term outcome even for nonresponding patients who received standard regimen.

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“…Several reports [2,14,15] showed, without disagreement among authors, that survival rates in patients with regional lesions (stage 111) were better when the tumor was completely excised. On the other hand, long-term survival rates for patients with stage IV, especially stage IVA, are not yet satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of patients with advanced neuroblastoma surviving more than 5 years after initiation of an intensive Japanese protocol: A report from the study group of Japan for treatment of advanced neuroblastoma

Iwafuchi¹,

Utsumi²,

Tsuchida³

et al. 1996

Med. Pediatr. Oncol.

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Improvement in survival after excision of primary tumor in stage III neuroblastoma

Cited by 77 publications

References 19 publications

Unresectable localized neuroblastoma: improved survival after primary chemotherapy including carboplatin-etoposide

Unresectable localized neuroblastoma: improved survival after primary chemotherapy including carboplatin-etoposide

Localised and unresectable neuroblastoma in infants: excellent outcome with low-dose primary chemotherapy

Evaluation of patients with advanced neuroblastoma surviving more than 5 years after initiation of an intensive Japanese protocol: A report from the study group of Japan for treatment of advanced neuroblastoma

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