Successful management of low-stage neuroblastoma without adjuvant therapies: a comparison of two decades, 1972 through 1981 and 1982 through 1992, in a single institution.

Abstract

PURPOSE A review was undertaken of 119 children seen at the Children's Hospital of Philadelphia between 1972 and 1992 to assess the impact of adjuvant therapies for patients with low-stage neuroblastoma (NBL). PATIENTS AND METHODS Twenty-one of 119 International Neuroblastoma Staging System (INSS) stage 1, 2a, 2b, and 4s patients seen received initial adjuvant treatment postoperatively and 98 did not. The patients were further subdivided according to decade, age, presence of residual disease, and lymph node status. Outcomes were then compared. RESULTS The event-free survival (EFS) rate for those who received adjuvant therapy was 52% versus 86% for those who did not. The 5-year survival rate was 68% and 94%, respectively. Age (< or > 12 months), extent of residual disease, and status of lymph nodes did not influence survival. Over the two decades, the reasons for selecting treatment changed as new and powerful additional prognostic factors were identified; 71% of patients received no adjuvant treatment in the first decade, compared with 90% in the second. EFS rates for untreated patients by decade were 79% and 89%, and 5-year survival rates were 85% and 98%, respectively. CONCLUSION It is possible to define most low-stage NBL as favorable-even in patients with positive lymph nodes and gross residual disease-and to omit initial adjuvant treatments successfully.