Multimodal Treatment of Advanced Neuroblastoma with Intensive Chemotherapy

Twenty-two pediatric patients with a stage IV-A or IV-B neuroblastoma have been treated with multimodal therapy consisting of intensive chemotherapy and surgery at Niigata University Hospital since 1985. The patients first received six cyclic courses of intensive chemotherapy ［regimen A_1］, consisting of cyclophosphamide ［1,200mg/m^2］, vincristine ［1.5mg/m^2], tetrahydropyranyl adriamycin ［pyrarubicin 40mg/m^2］, and cisplatin ［90mg/m^2］. Primary tumors and involved regional lymph nodes were removed sometime during first six cycles of chemotherapy. After the six cycles of ［Regiment A_1］, patients received alternating treatment with ［Regimen A_2］consisting of cyclophophamide ［1,500mg/m^2］, THP-adriamycin ［50mg/m^2］, cisplatin ［90mg/m^2］, and ［Regimen C］consisting of cyclophosphamide ［1,500mg/m^2］, DTIC ［250mg/m^2］. Two-year survival rate was 59%. Nine patients have now survived with disease free at 2 years after initiation of the treatment （survival rate: 41%）. From the viewpoint of prognosis, the influencing factors are as follows: small round cell type, diploidy, VMA（－）, NSE more than 100ng/ml, N-myc over 8 times of normal value