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Liver involvement in neuroblastoma: the Memorial Sloan-Kettering Experience supports treatment reduction in young patients.

AbstractBACKGROUND:
We reviewed clinical and biologic findings in a series of infants with neuroblastoma (NB) in liver. The aim was to gain insights into improving therapy.
PATIENTS AND METHODS:
Among 19 newly or recently diagnosed infants with NB in liver, 1987-2002, those with stage 4 involving bone received chemotherapy, while those without bone or extensive bone marrow (BM) involvement were observed or received limited treatment if NB caused life-threatening symptoms. We assessed results in the context of NB treatment risk stratification, which is based on age, stage, and selected biologic features (MYCN, ploidy, histology).
RESULTS:
Six of eight infants with bone involvement became long-term event-free survivors including 1/2 with MYCN amplification and four who received only 4-6 cycles of chemotherapy; at the end of treatment, four infants had abnormalities in liver +/- the primary site, but these resolved. All 11 infants without bone lesions became long-term survivors with either no cytotoxic therapy or only one cycle of chemotherapy (+/- radiotherapy to liver), including four who had stage 4 and one stage 4S patient who still had NB in BM at age 15 months.
CONCLUSIONS:
Treatment reduction should be considered for subsets of infants with non-MYCN-amplified widespread NB: stage 4 without bone or extensive BM involvement may not require cytotoxic therapy, stage 4S with symptomatic hepatomegaly may not require multiple cycles of chemotherapy, and classic stage 4 may do well with limited chemotherapy. Persistent liver abnormalities post-treatment may not require continued therapy to achieve a radiologic complete remission.
AuthorsBrian H Kushner, Kim Kramer, Michael P LaQuaglia, Shakeel Modak, Nai-Kong V Cheung
JournalPediatric blood & cancer (Pediatr Blood Cancer) Vol. 46 Issue 3 Pg. 278-84 (Mar 2006) ISSN: 1545-5009 [Print] United States
PMID16124002 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Topics
  • Bone Marrow Neoplasms (mortality, pathology, secondary, therapy)
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Liver (pathology)
  • Liver Neoplasms (mortality, pathology, secondary, therapy)
  • Male
  • Neuroblastoma (mortality, pathology, therapy)
  • Remission Induction
  • Retrospective Studies

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