Treatment of advanced neuroblastoma with emphasis on intensive induction chemotherapy: a report from the Study Group of Japan

Article Abstract:

Neuroblastoma is a malignant, bleeding tumor composed of neuroblasts, which give rise to cells of the sympathetic nervous system. This cancer develops mainly in infants and children. The effectiveness of intensive induction chemotherapy with cyclophosphamide, vincristine, tetrahydropyranyl adriamycin, and cisplatin was assessed in 109 patients with advanced neuroblastoma. The patients were enrolled into the study between January 1985 and May 1989, and consisted of infants less than one year of age with Stage IV A disease and children aged one year and older with Stage III or IV disease. In Stage IV A, the cancer has spread to the bone cortex, distant lymph node, or remote organs. In Stage III or IV, the tumor has spread only to the bone marrow, liver, and skin. The initial tumors and affected lymph nodes were surgically removed during intensive chemotherapy. After six cycles of chemotherapy, the patients were divided into three groups. One group received alternating treatment with cyclophosphamide and ACNU, a nitrosourea compound, as well as the initial intensified regimen. The second group received alternating treatment with cyclophosphamide and dacarbazine (DTIC) in addition to the intensified initial regimen. The last group of patients was treated with chemotherapy followed by bone marrow transplantation. The survival rates in Stage III patients were 77 percent at two years and 70 percent at three years, and in Stage IV patients, 54 percent at two years and 45 percent at three years. The major toxic effects included bone marrow suppression with decreases in white blood cell numbers to 100 per cubic millimeter; mild inflammation of the bladder, and hearing impairment. The survival rate was 78 percent in patients who went into complete remission after bone marrow transplantation. These findings show that intensive induction chemotherapy increases the rate of complete response and improves the results of treatment with bone marrow transplantation in patients with advanced neuroblastoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bone marrow, Bone marrow transplantation, Neuroblastoma

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Chemotherapy for recurrent or metastatic carcinoma of the nasopharynx: a review of the Princess Margaret Hospital experience

Article Abstract:

Nasopharyngeal carcinoma, a form of cancer affecting the mouth and nasal cavities, is, by definition, a cancer of the head and neck. However, grouping this form of cancer with other forms of head and neck cancer may obscure important differences, and conclusions based on studies of head and neck cancer may not be applicable to nasopharyngeal carcinoma. In particular, chemotherapy is thought to be of little benefit for head and neck cancer that has either recurred or metastasized to distant parts of the body. This may not be the case for nasopharyngeal carcinoma. A review was conducted of 70 patients with nasopharyngeal carcinoma who developed recurrent disease or distant metastatic disease after radiotherapy, the standard treatment for this cancer. Patients who received adjuvant chemotherapy as a part of their initial radiotherapeutic treatment protocol were not included in the study. Following their relapse, 30 patients were treated with a chemotherapeutic regimen considered to be aggressive, while a more moderate regimen was used to treat the remainder. Of the 40 who received nonaggressive chemotherapy, 10 experienced either complete responses (three patients) or partial responses (seven), for a response rate of 25 percent. Among the 30 patients treated more aggressively, 7 enjoyed complete responses and 14 achieved partial responses, for a total response rate of 70 percent. Two patients treated with an aggressive chemotherapeutic protocol remain alive without signs of disease 3 and 12 years later. It is impossible to determine on the basis of a case review which details of chemotherapeutic treatment might be most advantageous. However, the results clearly indicate that some patients with recurrent or metastatic nasopharyngeal carcinoma may benefit significantly from aggressive chemotherapy. The general lack of benefit received by patients with most head and neck cancers should not be assumed to apply to this special subset of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Head and neck cancer

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Chemotherapy as treatment of choice in extrapulmonary undifferentiated small cell carcinomas

Article Abstract:

The first description of an extrapulmonary small-cell carcinoma (cancer) appeared in 1930. Since that time, this small-cell carcinoma has come to be increasingly recognized as a distinct clinical entity. The tissues most often involved are the salivary glands, pharynx, larynx, esophagus, stomach, colon, rectum, and cervix. Though some small-cell carcinomas are slow to progress, small-cell carcinomas of the pharynx, esophagus, and paranasal sinuses are rapidly progressive, and untreated patients typically die quickly. In a study involving 11 patients, several chemotherapeutic protocols were used in an attempt to induce remission. Nine patients, including all those who were to achieve complete response or long-term survival, received intravenous doxorubicin, cyclophosphamide, and etoposide. Six patients achieved a complete response to the chemotherapy; five of those six had limited disease. It is worth noting that in two patients with metastatic small-cell carcinoma of the cervical lymph nodes, prolonged survival was observed although the primary tumor could not be located. These two patients remained disease-free at the 12- and 22-month follow-ups. The overall median survival rate was 12 months. Long-term survival was achieved in four of the five patients with limited disease. Chemotherapy appears to be the treatment of choice, with additional radiation therapy indicated in some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Antineoplastic agents, Cancer

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