BACKGROUND: Stage 4 and @entity4180 amplified (MNA) @entity521 in @entity1 have a poor prognosis. Our aim was to increase initial and long-term response in this population. PROCEDURE: High-risk @entity1 were studied according to the International @entity521 Staging System, then treated with high-dose @entity786 and high-dose @entity3003 , followed by surgery and autologous stem cell transplant or maintenance chemotherapy. RESULTS: From June 1992 to December 1998, 83 @entity1 were admitted in the study (72 stage 4> 1 year, 5 stage 4 MNA @entity1 , and 6 MNA stage 3 @entity1 ); @entity5 tissue was obtained from 73, @entity4180 was performed in 65, being amplified in 21 (32%). Induction chemotherapy was administered in the expected time in 35% of @entity1 . Its @entity137 was mainly hematologic followed by @entity281 , and there were 3 chemotherapy-related @entity204 . Delayed surgery was performed on 60 @entity1 with complete or >90% resection in 80% of cases. Chemotherapy plus surgery produced some response in 90% of @entity1 , 53% were in CR/VGPR; 49 @entity1 received autologous SCT, and 16 received maintenance chemotherapy for 9 months. Follow-up ranges are 1-87 months, mean 30 months. S and EFS at 4 years are 0.33 (SD 0.02). CONCLUSIONS: High-dose @entity786 and high-dose @entity3003 are effective in the initial treatment of @entity521 ; combined with surgery they produce some response in most @entity1 . Nevertheless, the CR/VGPR rate reaches only 53%. Survival time has also been prolonged but most @entity1 relapse with @entity3 .

Outcome of high-risk XXXX using a dose intensity approach: improvement in initial but not in long-term results.

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'infants'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity3003 :: ('MESH:D016190', 'Chemical') :: ['carboplatin'] @entity786 :: ('MESH:D003520', 'Chemical') :: ['cyclophosphamide'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infections'] @entity521 :: ('MESH:D009447', 'Disease') :: ['neuroblastoma', 'Neuroblastoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases'] @entity4180 :: ('4613', 'Gene') :: ['MYCN'] @entity204 :: ('MESH:D003643', 'Disease') :: ['deaths']
@entity521 :: (MESH:D009447,Disease) :: ['neuroblastoma']
