Chemotherapy of advanced neuroblastoma: does adriamycin contribute?

Between 1970 and 1977, 69 children with newly diagnosed stage III or IV neuroblastoma were treated with pulses of either cyclophosphamide and vincristine (CV) (n = 23), or cyclophosphamide, vincristine, and adriamycin (CVA) (n = 46). The 'complete' and partial response rates were 35 and 22% to CV, and 43 and 26% to CVA. For 'complete' responders the median time to relapse was 18 months for those treated with CV, and 17 months for those treated CVA; for partial responders the times were 5 and 7 months respectively. At 2 1/2 years only 17% of the CV patients and only 13% of the CVA patients were alive and free of disease, giving a 15% overall survival rate. The addition of adriamycin to cyclophosphamide and vincristine did not significantly improve the response rate, duration of response, or survival in these children with advanced neuroblastoma. The previously noted favourable effects of age less than 1 year at diagnosis and of female sex were confirmed. The equally poor survival for stage III and stage IV patients justifies the inclusion of stage III patients in a bad prognosis group.