The role of chemotherapy in the treatment of children with neuroblastoma stage IV: The GPO (German Pediatric Oncology Society) experience

Abstract

340 consecutive patients with neuroblastoma stage IV were analyzed for the possible impact of chemotherapy on general condition, remission status, event free survival and survival. The children entered the trials NB 79, NB 82 and NB 85 of the German Pediatric Oncology Society (GPO). The patients did benefit from chemotherapy by considerable improvement of the general condition, by achievement of 30-40% complete and 60-70% partial remissions. The event free survival (EFS) rate 5-8 years after diagnosis was 13% for all 299 protocol patients, the survival (S) rate 10%. The median/mean EFS time were 11.6/23.8 months, the median/mean S time 17.0/29.4 months. The use of response rates as early predictors for long term survival is challenged. Addition of PCVm (cisplatinum, cyclophosphamide, Vm 26) to ACVD (adriamycine, cyclophosphamide, vincristine, dacarbazine) in trial NB 82 resulted in an improvement of the long term EFS rate from 5% to 18% (S rates 7----21%). The introduction of IVp (ifosfamide, VP16) and increase of doses (cisplatinum, Vm 26) did not further improve the results. Maintenance therapy (NB 82) revealed a positive influence on the outcome. Shorter intervals for realization of chemotherapy were associated with a trend for better EFS (NB 85). Although the group of children with bone marrow transplantation showed better EFS and S data compared to the unselected chemotherapy group, the advantage was less clear if matched pairs (remission status at the time of BMT) were compared.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Our experience can be added to the limited number of other papers comparing different consolidation strategies after a common induction phase, thus making the results of these strategies fully comparable. These studies evaluated megatherapy vs continuing intensive chemotherapy (Matthay et al, 1999), or maintenance chemotherapy (Berthold et al, 1990;Castel et al, 2001), or no treatment (Pritchard et al, 2005). Combined with the other experiences including megatherapy, they reliably support the conviction that this consolidation treatment modality offers an advantage in terms of survival probability (McCowage et al, 1995;Kushner et al, 2001;Frappaz et al, 2002;Kaneko et al, 2002;Kletzel et al, 2002;De Bernardi et al, 2003).…”

Detection of human tumor cells by amplicon fusion site polymerase chain reaction (AFS-PCR)

“…The tumors were classified according to INSS criteria (33). All patients were treated according to previously described protocols (34,35), and informed consent for therapy and study procedures was obtained. The studies were reviewed and approved by the Ethics Committee of the medical faculty of the University of Cologne (Cologne, Germany).…”

Inhibition of TRAIL-induced apoptosis by Bcl-2 overexpression

“…Resistance of many tumors such as neuroblastoma to current treatment protocols still remains a major concern in cancer therapy (Berthold et al, 1990). Deregulated apoptosis programs may contribute to tumor progression and treatment resistance (Debatin, 1997;Kaufmann and Earnshaw, 2000).…”