RESUMEN
Nine children with neuroblastoma and five with Ewing sarcoma were found at diagnosis to have epidural extension of tumor. Five children underwent laminectomy prior to referral, with good neurologic recovery in only one. Management in the other nine children did not include laminectomy. All 14 patients were given chemotherapy without radiotherapy. Rapid regression of tumor with neurologic recovery occurred in response to chemotherapy in all patients with neurologic deficits. The responses observed in these children indicate that for chemotherapy-sensitive tumors, effective chemotherapy is a feasible alternative to laminectomy and radiation therapy in the management of epidural disease.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Laminectomía , Neuroblastoma/tratamiento farmacológico , Sarcoma de Ewing/tratamiento farmacológico , Neoplasias de la Médula Espinal/tratamiento farmacológico , Adolescente , Neoplasias Óseas , Niño , Preescolar , Terapia Combinada , Espacio Epidural , Humanos , Lactante , Neoplasias del Mediastino , Neuroblastoma/radioterapia , Neuroblastoma/secundario , Neuroblastoma/cirugía , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/secundario , Sarcoma de Ewing/cirugía , Neoplasias de la Médula Espinal/radioterapia , Neoplasias de la Médula Espinal/secundario , Neoplasias de la Médula Espinal/cirugíaAsunto(s)
Cisplatino/efectos adversos , Pérdida Auditiva de Alta Frecuencia/inducido químicamente , Pérdida Auditiva/inducido químicamente , Adolescente , Umbral Auditivo , Preescolar , Cisplatino/uso terapéutico , Pérdida Auditiva de Alta Frecuencia/diagnóstico , Humanos , Neoplasias/tratamiento farmacológicoRESUMEN
Of 254 children with neuroblastoma treated at St. Jude Children's Research Hospital, 102 (40%) had clinically localized tumors. Using a surgicopathologic staging system, 66 of these 102 children had localized tumor and 36 had tumor dissemination to regional lymph nodes. Survival of these two groups has been markedly different; 57 of 66 (87%) with localized tumor survive, compared with 11 of 35 (33%) with node dissemination, five of whom are less than two years from diagnosis. Our data indicate that the prognosis for children with neuroblastoma metastatic only to regional lymph nodes is no different from that of patients of similar age with widely disseminated tumor.