UNASSIGNED: 8562 Background: Poor therapeutic response in advanced @entity521 prompted us to implement St. Jude's Protocol [NB - 84, TMH NB-2] since 1987 and @entity1260 based chemotherapy [ICE, TMH NB-3] since 1996 with the aim to improve survival rate with manageable @entity137 . METHODS: 128 cases of @entity521 from 1987 to 2000 were analysed. In @entity1 (n = 29) median age at presentation 9 months, duration of symptoms 60 days, M: F:: 1.6: 1. An asymptomatic abdominal mass (62%) as a commonest presenting symptom _ primary site (62.1%). Stage III(17), IV(1) received 6 # of @entity632 _ @entity786 or 1 -2 # of @entity632 , @entity786 , @entity900 _ @entity2879 . Surgery considered after 3/6 # or 1/2# of chemotherapy respectively. In @entity1 > l year (n=99) median age at presentation 48 months, duration of symptoms 60 days, M: F:: 1.3: 1. Commonest presenting symptom as fever (51%) _ primary site as abdomen (66.7%). Stage IIB(3),III(30), IV(60) received 1cycle of TMH NB-2 as induction followed by either 2# of TMH NB-2 or 4 # TMH NB-3 as consolidation. In StageIII surgery offered after induction, whereas in stageIV at the end of consolidation. Radiotherapy or 131I @entity7990 treatment was given where surgery not feasible or in R1 resection. ABMT was offered for gross @entity66 when economically feasible _ 13 Cis @entity1968 for minimal @entity66 in stage IV. RESULTS: Infantile group 62% constituted intermediate risk (stage III, IV). Overall response (CR+VGPR+PR) to therapy was 97%. @entity3012 is 75.06%. 58% are alive _ disease free at a median follow-up of 42.9 months. In @entity1 >1year 94% constituted high risk (IIB, III, IV).74% showed response to therapy. @entity3012 is 54.31%. 18.6 % are alive _ disease free at a median follow up of 14.9 months. CONCLUSIONS: High risk @entity1 remains an area of concern in our setting. Proper risk stratification has not been possible at our center _ remains the main constraint in tailoring therapy. Innovative _ aggressive treatment strategies to improve survival _ response rates now remains a need of time. No significant financial relationships to disclose.

Challenges in management of advanced XXXX : Experience at Tata Memorial Hospital, Mumbai, India.

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'infants'] @entity632 :: ('MESH:D004317', 'Chemical') :: ['adriamycin'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicities'] @entity66 :: ('MESH:D004194', 'Disease') :: ['residual disease'] @entity3012 :: ('MESH:C567932', 'Disease') :: ['OS'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['Cisplatin'] @entity786 :: ('MESH:D003520', 'Chemical') :: ['cyclophosphamide'] @entity7990 :: ('MESH:D019797', 'Chemical') :: ['MIBG'] @entity2879 :: ('MESH:D005047', 'Chemical') :: ['Etoposide'] @entity521 :: ('MESH:D009447', 'Disease') :: ['neuroblastoma'] @entity1260 :: ('MESH:D007069', 'Chemical') :: ['Ifosfamide'] @entity1968 :: ('MESH:D014212', 'Chemical') :: ['Retinoic acid']
@entity521 :: (MESH:D009447,Disease) :: ['neuroblastoma']
