ABSTRACT
Multivariate analysis on an unselected patient population consisting of all 253 children treated for neuroblastoma in Denmark during 1943 to 1980 shows that stage, age, and treatment given are independent prognostic variables. Calendar year of diagnosis, sex of the patient, and site of primary tumor were not significant prognostic factors. Further analysis shows that multimodal treatment with surgery, irradiation, and chemotherapy, especially in patients older than 1 year of age with Stage II disease, has influenced the survival significantly. The fact that age at diagnosis and the administration of chemotherapy have independent prognostic significance can be explained by the theory that all neuroblastomas are virtually congenital; therefore, the difference in age at diagnosis largely reflects the difference in growth rates of the tumor. Thus, according to this theory, age may be a measure of the probability of micrometastases in addition to the clinical extent or stage of the disease, as it represents the duration of the disease. Additional chemotherapy may thus have eradicated these micrometastases in the older children, since the age influence on Stage II disease disappeared when multimodal treatment was given in this study. The implications for treatment policy are discussed in view of this theory.
Subject(s)
Neuroblastoma/mortality , Age Factors , Child , Child, Preschool , Denmark , Female , Humans , Male , Neuroblastoma/therapy , Prognosis , Regression Analysis , Sex FactorsABSTRACT
One hundred and eighty cases of neuroblastomas from the four child oncology clinics are reviewed. The overall cure rate was 24%. During the 38-year period, there was a significant increase in survival from 0% during the period of 1943-1950 to 32% during the period of 1971-1980. This improved survival rate is most likely a result of adjuvant chemotherapy. Forty percent of the patients appear chronically ill, which reflects the fact that nearly 60% have metastases when they are first seen. In localized disease (stages I-II), the prognosis was favourable (cure rate 69%), while the prognosis for disseminated disease (stage III-IV) was poor (cure rate 5%). A favourable outcome was seen in patients under 1 year (survival rate 46%), and in patients with primary tumours located in the neck or mediastinum (survival rate 48%). When related to stage, however, the survival rates for the former tumours were not significantly better in patients below 1 year or in patients with cervical or thoracic tumours. As is the case in other studies, we found that survival is significantly poorer in males.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neuroblastoma/drug therapy , Abdominal Neoplasms/drug therapy , Adrenal Gland Neoplasms/drug therapy , Child, Preschool , Combined Modality Therapy , Head and Neck Neoplasms/drug therapy , Humans , Infant , Neoplasm Staging , Neuroblastoma/diagnosis , Neuroblastoma/pathology , Prognosis , Radiotherapy Dosage , Thoracic Neoplasms/drug therapy , Vanilmandelic Acid/urineABSTRACT
In 28 children with acute lymphoblastic leukemia (ALL) computed tomography (CT) was performed in order to demonstrate possible cerebral changes following treatment with prophylactic irradiation and intraspinal methotrexate (MTX). The time of CT-scan examination varied from 1 year and 1 month to 10 years and 1 month after diagnosis of ALL. The age of the children ranged from 3 years and 11 months to 14 years and 5 months. Six children had normal CT scans, 12 children had slight atrophy-like changes, and nine had severe cerebral atrophy. Two patients in the latter group presented an enlarged ventricular system as well. In one patient intracerebral calcification was the only pathologic finding. The severe changes were seen in children of all age groups, but predominantly in children with a short duration of their disease, severe symptoms, and frequent marrow relapse. Changes induced by steroid therapy may be reversible. No satisfactory explanation of the demonstrated cerebral pathologic findings can be given, except that they are the consequences of the combination of total therapy and severity of disease in the individual patient. Measurement of attenuation coefficients in grey and white matter shows increasing values with age during childhood. A combination of decreasing attenuation coefficients, especially in the white matter, and the finding of severe atrophy seems to be a bad prognostic sign.
