Background & objective: About 30% of neuroblastoma patients have poor response to first-line chemotherapy or progress during chemotherapy. Although advanced neuroblastoma patients could achieve complete remission after combined treatment, most of them relapsed finally. This study was to evaluate the efficacy of ifosphamide and carboplatin as a salvage chemotherapy regimen on recurrent or refractory neuroblastoma.
Methods: Nine refractory neuroblastoma patients and 23 recurrent neuroblastoma patients were treated with ifosphamide (1.5 g/m(2) daily for 5 days) and carboplatin (400 mg/m(2) on day 1). Mesna was applied at a dosage of 20% of ifosfamide 3 times at 4-hour intervals after termination of the ifosfamide infusion. Chemotherapy was administered every 2-3 weeks.
Results: None of the 32 patients achieved complete remission; 19 (59.4%) achieved partial remission. The median remission time was 4.2 months (1-28 months). After chemotherapy, 8 patients received operation to resect tumors. Main adverse events included grade III-IV neutropenia (44.7%), grade III-IV thrombocytopenia (53.1%), neutropenia accompanied with infection (18.8%), grade I liver dysfunction (12.5%), and hemorrhagic cystitis (9.4%). All adverse events were reversible.
Conclusions: Recurrent and refractory neuroblastoma responds well to chemotherapy regimen of ifosphamide plus carboplatin. The toxicities are tolerable. But the long-term prognosis is poor. More effective strategies are needed to improve its long-term survival.