Neuroblastoma in adolescents and adults: The Memorial Sloan‐Kettering experience

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Abstract
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 2B (n = 1), 3 (n = 2), or 4 (n = 27) NB. Treatments included conventional and myeloablative therapy; local radiotherapy (RT); immunotherapy with anti‐GD2 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/VGPR) 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. Med Pediatr Oncol 2003;41:508–515.

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