Sequential cyclophosphamide and doxorubicin for induction of complete remission in children with disseminated neuroblastoma

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Abstract
When 70 children with disseminated neuroblastoma were treated for 4 months with a course of cyclophosphamide and doxorubicin (Adriamycin) 35 (52%) of 68 assessable patients achieved complete remissions, 13 had partial responses, and 20 had either less than a 50% regression of tumor or evidence of tumor progression. Of the 35 children with complete responses, three received local irradiation, but for the remainder, chemotherapy alone provided rapid control of tumor growth. Drug-induced toxicity caused the hospitalization of four of 17 infants and five of 52 older children, but was related to only two of the eight deaths that occurred during treatment. Infants less than 1 year of age were more likely to achieve a complete remission than were older children. That 52% of these patients achieved complete remissions represents a marked improvement over the 22% response rate for patients seen between 1962 and 1974. Of 35 patients with complete responses, 15 have survived, contrasted with only four of 33 patients achieving less than a complete response. Median survival for patients achieving a partial response was 14.4 months, compared to 8.4 months for patients not achieving a response. A kinetically based sequence of chemotherapy seems to produce a high rate of complete remissions in children with disseminated neuroblastoma. To consolidate this gain into curative treatment will require a continuation therapy to prevent the emergence of drug-resistant disease.