Klin Onkol 1996; 9(6): 183-186.
Summary:
Neuroblastoma is the second most frequent solid tumor. In advanced neuroblastoma the poor outlook with conventional chemotherapy has stimulated investigation of forms of massive therapy. Megatherapy with autologous bone marrow transplantation is now an established treatment modality in pediatric oncology. Current results from several centres indicate that although the median survival is increased, long-term survival is unlikely to exceed 40% with current regimens. We reviewed the usefulness of total body irradiation as a part of conditioning regimens with high dose drug combinations in comparison to conditioning with high dose drug combinations only. Since November 1992 to May 1996, 23 children with high risk neuroblastoma were transplanted. Twelve patients were treated by a TBI and chemotherapy and eleven children by chemotherapy only. The conditioning regimens combined myeloablative chemotherapy - carboplatinum, etoposide, melphalan with 10 Gy of hyperfractionated total body irradiation or carboplatinum, etoposide and melphalan alone. Days of hospitalisation and febrile days were higher in TBI patients. Significantly unfavourable impact on acute and late disorders in spite of some specific complications was not proved. In the group of patients with TBI, seven patients have progression free survivals (58,3%) compared to four patients (48%) in group with no TBI in conditioning regimens (median time of observation 14 and 13,5 months). This trend is not statistically significant yet. An extensive, randomised multicentric trial will be necessary to evaluate the real importance of TBI more exactly in children with neuroblastoma.
