Neuroblastoma: An Evaluation of Its Natural History and the Effects of Therapy, with Particular Reference to Treatment by Massive Doses of Vitamin B12

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Abstract
These five cases included four infants (two newborn, one aged 3 months and one aged 4 months) as well as one baby aged 18 months. Three cases were instances of Pepper''s syndrome. All but one of these five cases were treated with vitamin B12 only; the one exception had 1,000 rad as well. They all responded extremely well to therapy. One case of Pepper''s syndrome has been followed for one year, one case for one year and four months, one case for one year and two months, one case for five years and one case for four years and seven months. The two cases other than those of Pepper''s syndrome were one instance of extradural neuroblastoma with spinal block, now perfectly well after five years, and one case of multiple subcutaneous neuroblastoma nodules, well after four years and seven months. The only case treated by irradiation (as well as vitamin B12) was an instance of Pepper''s syndrome, now well after one year and two months. It is interesting to note that two of the cases of Pepper''s syndrome who had been treated with vitamin B12 only, showed gradual return to normal urinary V.M.A. excretion pari passu with clinical improvement. This miscellaneous series has been recorded for it contains, in addition to the relatively small purely vitamin B12-treated children from this hospital, another four such examples. The serial V.M.A. estimations leading to normal levels in two instances are also worthy of note.

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