Abstract | BACKGROUND: 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.
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Authors | Brian H Kushner, Kim Kramer, Michael P LaQuaglia, Shakeel Modak, Nai-Kong V Cheung |
Journal | Pediatric blood & cancer
(Pediatr Blood Cancer)
Vol. 46
Issue 3
Pg. 278-84
(Mar 2006)
ISSN: 1545-5009 [Print] United States |
PMID | 16124002
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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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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