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Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents.

Publication ,  Journal Article
West, DC; Shamberger, RC; Macklis, RM; Kozakewich, HP; Wayne, AS; Kreissman, SG; Korf, BR; Lavally, B; Grier, HE
Published in: J Clin Oncol
January 1993

PURPOSE: A nonrandomized, single-arm trial was conducted to assess the efficacy of multimodality therapy including intensive chemotherapy with multiple alkylating agents in the treatment of children with Evans stage III neuroblastoma older than 1 year at diagnosis. PATIENTS AND METHODS: Twenty-five patients with a median age of 18 months at diagnosis were treated with multimodality therapy including surgery and chemotherapy using either nitrogen mustard (mechlorethamine), doxorubicin, cisplatin, dacarbazine (DTIC), vincristine, and cyclophosphamide (MADDOC) or cisplatin and cyclophosphamide induction followed by maintenance MADDOC (induction MADDOC) protocols. Sixteen of 25 patients also received radiotherapy to the tumor bed and primary lymph nodes. Event-free survival (EFS) was compared with that reported previously in the literature. N-myc amplification was evaluated prospectively and the Shimada classification was evaluated retrospectively as potential prognostic factors. RESULTS: We report a 72% EFS (95% confidence interval +/- 18%) with a median follow-up of 85 months. EFS was significantly worse for patients with tumors demonstrating N-myc amplification (P = .018). Patients classified as favorable according to the Shimada system experienced a significantly better EFS (P = .04), but unfavorable patients still maintained a 60% EFS. CONCLUSION: Intensive multimodality treatment including MADDOC and induction MADDOC chemotherapy provides a very good EFS for children older than 1 year who have stage III neuroblastoma. Children classified as favorable according to the Shimada system have a better prognosis. Patients whose tumors demonstrate N-myc amplification have a poor prognosis despite therapy.

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Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

January 1993

Volume

11

Issue

1

Start / End Page

84 / 90

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Neoplasm Staging
  • Infant
  • Humans
  • Genes, myc
  • Gene Amplification
 

Citation

APA
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ICMJE
MLA
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West, D. C., Shamberger, R. C., Macklis, R. M., Kozakewich, H. P., Wayne, A. S., Kreissman, S. G., … Grier, H. E. (1993). Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents. J Clin Oncol, 11(1), 84–90. https://doi.org/10.1200/JCO.1993.11.1.84
West, D. C., R. C. Shamberger, R. M. Macklis, H. P. Kozakewich, A. S. Wayne, S. G. Kreissman, B. R. Korf, B. Lavally, and H. E. Grier. “Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents.J Clin Oncol 11, no. 1 (January 1993): 84–90. https://doi.org/10.1200/JCO.1993.11.1.84.
West DC, Shamberger RC, Macklis RM, Kozakewich HP, Wayne AS, Kreissman SG, et al. Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents. J Clin Oncol. 1993 Jan;11(1):84–90.
West, D. C., et al. “Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents.J Clin Oncol, vol. 11, no. 1, Jan. 1993, pp. 84–90. Pubmed, doi:10.1200/JCO.1993.11.1.84.
West DC, Shamberger RC, Macklis RM, Kozakewich HP, Wayne AS, Kreissman SG, Korf BR, Lavally B, Grier HE. Stage III neuroblastoma over 1 year of age at diagnosis: improved survival with intensive multimodality therapy including multiple alkylating agents. J Clin Oncol. 1993 Jan;11(1):84–90.

Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

January 1993

Volume

11

Issue

1

Start / End Page

84 / 90

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Neoplasm Staging
  • Infant
  • Humans
  • Genes, myc
  • Gene Amplification