Nitschke R, Smith E I, Altshuler G, Altmiller D, Shuster J, Green A, Castleberry R, Hayes F A, Golembe B, Ducos R
Oklahoma University Health Sciences Center, Oklahoma City.
J Clin Oncol. 1991 Jul;9(7):1181-8. doi: 10.1200/JCO.1991.9.7.1181.
The Pediatric Oncology Group (POG) evaluated in a prospective study the hypothesis that patients who had localized, visible residual neuroblastoma without regional lymph node involvement after surgery (POG stage B) have a favorable prognosis when treated with moderate intensive chemotherapy. Eligible patients were initially treated with five courses of Cytoxan (cyclophosphamide; Bristol-Myers Squibb Co., Evansville, IN) and Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) followed by surgery (CY/AD +/- surgery). Those patients not achieving a complete remission (CR) crossed over to five courses of cisplatin and teniposide (PL/VM) +/- surgery. Radiation therapy (XRT) was given to selected patients who still were not in CR after the crossover therapy. Of the 61 eligible patients, 38 (62%) patients achieved CR after CY/AD proven by clinical (31) or surgical (seven) evaluation. One (2%) patient in clinical partial remission (PR-C) entered CR without further therapy. Nineteen (31%) patients achieved CR with the following salvage therapies: surgery (five), PL/VM +/- surgery (five) followed by XRT (three) or autologous bone marrow transplant (ABMT) (one) and further courses of CY/AD +/- PL/VM instead of courses of PL/VM (five). The overall CR rate was 95% (58 of 61). Four patients had recurrence of the disease. The probability of being disease-free at 3 years after initial or salvage therapy was estimated at 84% (SE, 5%). The overall prognosis of children older than 1 year and younger than 1 year was similar (P = .26). If, however, the three remission deaths (all younger than 1 year) were censored, there was only one other failure in 32 children younger than one versus seven of 29 children older than 1 year (P = .018). These results confirm the excellent prognosis for patients with POG stage B neuroblastoma and indicate that most patients are curable with CY/AD +/- surgery, and those not achieving CR with this therapy are curable with alternate therapy.
儿童肿瘤研究组（POG）在一项前瞻性研究中评估了以下假设：对于术后有局限性、可见残留神经母细胞瘤且无区域淋巴结受累的患者（POG B期），采用中等强度化疗治疗时预后良好。符合条件的患者最初接受五个疗程的环磷酰胺（Cytoxan；布里斯托-迈尔斯·斯奎布公司，印第安纳州埃文斯维尔）和阿霉素（阿霉素；阿德里亚实验室，俄亥俄州哥伦布）治疗，随后进行手术（CY/AD +/- 手术）。那些未达到完全缓解（CR）的患者转而接受五个疗程的顺铂和替尼泊苷（PL/VM）治疗 +/- 手术。对交叉治疗后仍未达到CR的部分选定患者给予放射治疗（XRT）。在61名符合条件的患者中，38名（62%）患者经临床（31名）或手术（7名）评估证实CY/AD治疗后达到CR。1名（2%）处于临床部分缓解（PR-C）的患者未接受进一步治疗即进入CR状态。19名（31%）患者通过以下挽救治疗达到CR：手术（5名）、PL/VM +/- 手术（5名），随后进行XRT（3名）或自体骨髓移植（ABMT）（1名），以及采用CY/AD +/- PL/VM疗程替代PL/VM疗程（5名）。总体CR率为95%（61名中的58名）。4名患者疾病复发。初次或挽救治疗后3年无病概率估计为84%（标准误，5%）。1岁以上和1岁以下儿童的总体预后相似（P = 0.26）。然而，如果剔除3例缓解期死亡患者（均小于1岁），则1岁以下的32名儿童中仅有1例其他治疗失败，而1岁以上的29名儿童中有7例（P = 0.018）。这些结果证实了POG B期神经母细胞瘤患者的良好预后，并表明大多数患者可通过CY/AD +/- 手术治愈，而那些该治疗未达到CR的患者可通过替代治疗治愈。
