Clinical Study

British Journal of Cancer (2005) 92, 1984–1988. doi:10.1038/sj.bjc.6602615 www.bjcancer.com
Published online 17 May 2005

Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment

R Luksch1, M Podda1, L Gandola2, D Polastri1, L Piva3, R Castellani4, P Collini5, M Massimino1, G Cefalo1, M Terenziani1, A Ferrari1, M Casanova1, F Spreafico1, C Meazza1, F Bozzi1, A Marchianò6, F Ravagnani7 and F Fossati-Bellani1

  1. 1Unità di Pediatria, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  2. 2Unità di Radioterapia, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  3. 3Unità di Chirurgia Urologica, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  4. 4Unità di Medicina Nucleare, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  5. 5Servizio di Anatomia Patologica e Istologia, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  6. 6Servizio di Radiodiagnostica, Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy
  7. 7Servizio Immunotrasfusionale. Istituto Nazionale Tumori di Milano, Via Venezian, 1-20133 Milan, Italy

Correspondence: Dr R Luksch, Unità Operativa Pediatria, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133 Milan, Italy. E-mail: roberto.luksch@istitutotumori.mi.it

Received 18 January 2005; Revised 4 April 2005; Accepted 5 April 2005; Published online 17 May 2005.

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Abstract

The aim of the present study was to evaluate the effectiveness of two consecutive nonrandomised treatment programs applied between 1989 and 1999 at the Istituto Nazionale Tumori of Milan in an unselected cohort of 59 children over the age of one with stage 4 neuroblastoma. Both treatment programs consisted of two phases, the induction of the remission phase and the consolidation phase. The induction of the remission phase consisted of intensive chemotherapy, and remained the same throughout the study period. The consolidation phase consisted of sequential hemi-body irradiation (HBI) (10 Gy per session, 6 weeks apart) in the first period (1988–June 1994) and sequential high-dose cyclophosphamide, etoposide, mitoxantrone+L-PAM and autologous haemopoietic stem cell transplantation in the second (July 1994–1999). Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03). This finding led us to conclude that sequential HBI is useless as consolidation treatment. The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted.

Keywords:

neuroblastoma, sequential hemi-body irradiation, autologous stem cell transplantation