|
|
Challenges in management
of advanced neuroblastoma: Experience at Tata Memorial Hospital, Mumbai, India
G. Biswas, P. Kurkure, S. Banavali, S. Achrekar, P. Kulkarni, R. Bhagwat, L.
Sharma
Tata Memorial Hospital, Mumbai, India
Background.
Poor therapeutic response in advanced neuroblastoma prompted us to implement
St. Jude's Protocol [NB - 84, TMH NB-2] since 1987 and Ifosfamide based
chemotherapy [ICE, TMH NB-3] since 1996 with the aim to improve survival rate
with manageable toxicities.
Methods.
128 cases of neuroblastoma from 1987 to 2000 were
analysed.
In infants (n = 29) median age at presentation 9 months, duration of symptoms 60
days, M: F:: 1.6: 1.
An asymptomatic abdominal mass (62%) as a commonest presenting symptom &
primary site (62.1%).
Stage III(17), IV(1) received 6 # of adriamycin & cyclophosphamide or 1 -2 #
of adriamycin, cyclophosphamide, Cisplatin & Etoposide.
Surgery considered after 3/6 # or 1/2# of chemotherapy respectively.
In children > l year (n=99) median age at presentation 48 months, duration of
symptoms 60 days, M: F:: 1.3: 1.
Commonest presenting symptom as fever (51%) & primary site as abdomen
(66.7%).
Stage IIB(3),III(30), IV(60) received 1cycle of TMH NB-2 as induction followed
by either 2# of TMH NB-2 or 4 # TMH NB-3 as consolidation.
In StageIII surgery offered after induction, whereas in stageIV at the end of
consolidation.
Radiotherapy or 131I MIBG treatment was given where surgery not feasible or in
R1 resection.
ABMT was offered for gross residual disease when economically feasible & 13
Cis Retinoic acid for minimal residual disease in stage IV.
Results.
Infantile group 62% constituted intermediate risk (stage III,
IV).
Overall response (CR+VGPR+PR) to therapy was 97%.
OS is 75.06%.
58% are alive & disease free at a median follow-up of 42.9 months.
In children >1year 94% constituted high risk (IIB, III, IV).
74% showed response to therapy.
OS is 54.31%.
18.6 % are alive & disease free at a median follow up of 14.9 months.
Conclusions.
High risk patients remains an area of concern in our
setting.
Proper risk stratification has not been possible at our center & remains the
main constraint in tailoring therapy.
Innovative & aggressive treatment strategies to improve survival &
response rates now remains a need of time.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-003079,00.asp
|
