Results of combination chemotherapy, surgery, and radiotherapy in children with neuroblastoma

A retrospective analysis of 46 histologically proven cases of neuroblastoma is presented. The over-all 2-year survival was 46%. All except 1 of the 21 patients surviving 2 years were continuously free of clinical and laboratory evidence of neuroblastoma. The patients treated before 1967 were treated with partial or complete surgical excision, if feasible, and low-dose postoperative radiation therapy with or without actinomycin-D or cyclophosphamide chemotherapy. In this group of 27 patients, 9 survived a 2-year period without recurrence, with a median survival of 11 months. All patients after 1967 received chemotherapy utilizing vincristine sulfate and cyclophosphamide. The patients in this group with early stage disease also had partial or complete surgical excision followed by adjunctive postoperative high-energy radiation therapy employing higher dosages. Among the 19 patients in this latter treatment group, 12 survived 2 years, with a median survival of 36 months. The age of the patient and the site and stage of the primary neuroblastoma influenced their prognosis. Although the number of patients surviving 2 years appeared increased with more aggressive therapy, the difference in survival between the two groups may be due to other factors, such as a different patient age and primary tumor site distribution at the time of diagnosis and treatment.