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Drugs

, Volume 59, Issue 6, pp 1261–1277 | Cite as

Neuroblastoma

Current Drug Therapy Recommendations as Part of the Total Treatment Approach
  • Frank Berthold
  • Barbara Hero
Disease Management

Abstract

Neuroblastoma represents one of the most challenging malignancies for treatment decisions because of its unusual biological behaviour. The features include spontaneous regression (regressive type), maturation to ganglioneuroma (maturative type) and largely treatment-resistant progression (progressive type). Current knowledge allows only partial prediction of type. For practical reasons, patients may be categorised as an ‘observation’, a ‘standard risk’ or a ‘high risk’ treatment arm.

During the last 2 decades, 5-year survival rates for children with neuroblastoma have increased from 48 to 67%. The main achievements were the reduction of chemotherapy in patients with localised disease and the increased efficacy of chemotherapy in metastatic neuroblastoma stage 4 (5-year survival increased from 8 to 33%). Different goals for chemotherapy (e.g. stopping rapid progression, improvement of symptoms, induction and maintenance of remission) require different dosages and durations of treatment (range 1 week to 9 months). The main risks of chemotherapy are toxic death (rate up to 15%) predominantly during the periods of bone marrow depression and the development of secondary leukaemias (up to 7% cumulative risk after 4 years).

In conclusion, the use of cytotoxic drugs can be completely omitted in a substantial proportion of low risk patients with neuroblastoma. On the other hand, for high risk patients with the disease, intensive polychemotherapy represents the basis and the backbone of treatment among other modalities.

Keywords

Neuroblastoma Teniposide Fenretinide Maintenance Chemotherapy Ganglioneuroma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work was supported by several grants of the Deutsche Krebshilfe. The excellent secretarial help of Mrs Pia Hadrich-Ruffing was greatly appreciated.

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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Children’s Hospital University of CologneCologneGermany

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