Neuroblastoma in adolescents and adults: The memorial Sloan-Kettering experience

Background. We reviewed the utility of different treatment modalities in a large series of adolescents/adults with neuroblastoma (NB). Procedure. The 30 adolescents/adults (median age, 19 years) had stage 2 B (n = 1), 3 (n = 2), or 4 (n = 27) NB. Treatments included conventional and myeloablative therapy; local radiotherapy (RT); immunotherapy with anti-G(D2) +/- 3F8 monoclonal antibody granulocyte-macrophage colony-stimulating factor (GM-CSF); and 3F8 alternating with low-dose oral etoposide. Results. Seven patients are in first (n = 4) or second (n = 3) complete/very good partial remission (CR/GPR) at 9+ to 181+ (median 45+) months. Among 13 newly diagnosed or minimally prior-treated patients, no major responses were seen in 4/4 treated with N4/N5 chemotherapy, but 6/9 treated with the higher dose N6/N7 regimens and surgery had major responses, and immunotherapy produced CR in BM in three patients. Among 17 patients referred because of resistant NB, favorable responses occurred in 6/12 treated with high-dose cyclophosphamide-based salvage therapy, including one patient who is in CR 170+ months after myeloablative consolidation and five patients who achieved CR/VGPR after 3F8/GM-CSF (n=4) or 3F8/oral etoposide (n=1). With a median follow-up of 32+ months post-RT, no local relapses occurred in 10/10 patients who received hyperfractionated 21 Gy RT to prevent regrowth of soft tissue masses that had been resected. Conclusions. High-dose chemotherapy and surgery can achieve a minimal disease state in >50% of newly diagnosed older NB patients. In that setting, local RT, and the use of agents with recently confirmed anti-NB activity, including anti-GD2 antibodies, and cis-retinoic acid, may improve the poor prognosis of these patients reported to date. (C) 2003 Wiley-Liss, Inc.