Radiotherapy improves the outlook for patients older than 1 year with Pediatric Oncology Group stage C neuroblastoma

R. P. Castleberry, L. E. Kun, J. J. Shuster, G. Altshuler, I. E. Smith, R. Nitschke, M. Wharam, N. McWilliams, V. Joshi, F. A. Hayes

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Abstract

Children older than 1 year of age who have neuroblastoma with complete or partial removal of the primary tumor and positive intracavitary lymph nodes (Pediatric Oncology Group [POG] stage C) are a small but higher-risk subset of patients. To further evaluate the importance of identifying patients with POG stage C neuroblastoma and to assess the efficacy and toxicity of adding concurrent radiation therapy (RT) to chemotherapy (CT) in these children, a randomized study was conducted. Eligible patients received cyclophosphamide 150 mg/m2 orally days 1 to 7 and Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) 35 mg/m2 intravenously (IV) on day 8 (CYC/ADR) every 3 weeks for five courses with or without RT to primary tumor and regional lymph nodes (24 to 30 Gy/16 to 20 fractions). Second-look surgery was advised to evaluate response and to remove residual disease. Continuation therapy alternated CYC/ADR every 3 weeks with cisplatin 90 mg/m2 day 1 followed by teniposide 100 mg/m2 day 3 (CDP/VM) for two courses each. Secondary CT with CDP/VM alone was available for patients not achieving complete response (CR) following induction treatment and second-look surgery. Of 29 eligible patients randomized to CT alone, 13 achieved CR, and nine are disease-free (NED) 1 to 52 months (median, 35 months) off therapy. Twenty-two of 33 eligible cases treated with CT/RT attained CR, and 19 are NED 1 to 77 months (median, 23 months) off therapy. Local and metastatic relapses occurred in both arms. Differences in CR, event-free survival, and survival rates were significant, P = .013, .009, and .008, respectively. Surgical compliance was excellent and complications uncommon. Therapy was tolerable in both groups but hematopoietic toxicity was more common in the CT/RT arm. We conclude that POG stage C neuroblastoma in children older than 1 year of age is a higher-risk group that should be identified, that CT/RT provides superior initial and long-term disease control compared with CT alone in this patient subset, and that the occurrence of metastatic failures in both treatment groups suggests a need for more aggressive chemotherapy.

Original languageEnglish (US)
Pages (from-to)789-795
Number of pages7
JournalJournal of Clinical Oncology
Volume9
Issue number5
DOIs
StatePublished - Jan 1 1991

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Neuroblastoma
Radiotherapy
Pediatrics
Drug Therapy
Second-Look Surgery
Cytidine Diphosphate
Doxorubicin
Therapeutics
Lymph Nodes
Teniposide
Cyclophosphamide
Cisplatin
Compliance
Disease-Free Survival
Neoplasms
Survival Rate
Recurrence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Castleberry, R. P., Kun, L. E., Shuster, J. J., Altshuler, G., Smith, I. E., Nitschke, R., ... Hayes, F. A. (1991). Radiotherapy improves the outlook for patients older than 1 year with Pediatric Oncology Group stage C neuroblastoma. Journal of Clinical Oncology, 9(5), 789-795. https://doi.org/10.1200/JCO.1991.9.5.789

Radiotherapy improves the outlook for patients older than 1 year with Pediatric Oncology Group stage C neuroblastoma. / Castleberry, R. P.; Kun, L. E.; Shuster, J. J.; Altshuler, G.; Smith, I. E.; Nitschke, R.; Wharam, M.; McWilliams, N.; Joshi, V.; Hayes, F. A.

In: Journal of Clinical Oncology, Vol. 9, No. 5, 01.01.1991, p. 789-795.

Research output: Contribution to journalArticle

Castleberry, RP, Kun, LE, Shuster, JJ, Altshuler, G, Smith, IE, Nitschke, R, Wharam, M, McWilliams, N, Joshi, V & Hayes, FA 1991, 'Radiotherapy improves the outlook for patients older than 1 year with Pediatric Oncology Group stage C neuroblastoma', Journal of Clinical Oncology, vol. 9, no. 5, pp. 789-795. https://doi.org/10.1200/JCO.1991.9.5.789
Castleberry, R. P. ; Kun, L. E. ; Shuster, J. J. ; Altshuler, G. ; Smith, I. E. ; Nitschke, R. ; Wharam, M. ; McWilliams, N. ; Joshi, V. ; Hayes, F. A. / Radiotherapy improves the outlook for patients older than 1 year with Pediatric Oncology Group stage C neuroblastoma. In: Journal of Clinical Oncology. 1991 ; Vol. 9, No. 5. pp. 789-795.
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