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ABSTRACT: To evaluate the efficacy of 21 Gy hyperfractionated radiotherapy for local control in conjunction with surgery and intensive systemic therapy for patients with Stage 4 neuroblastoma.
After achieving a partial or complete remission, 47 children, ages 1-10 years, with Stage 4 neuroblastoma were treated on four consecutive institutional protocols (N4-N7) with dose-intensive multi-agent chemotherapy, maximal surgical debulking, and hyperfractionated radiotherapy (1.5 Gy twice a day to 21 Gy). Radiotherapy fields encompassed the initial tumor volume and regional lymph nodes plus a 3-cm margin. This was followed by consolidation with either autologous bone marrow transplantation (N4 and N5) or immunotherapy (N6 and N7).
Forty-five of 47 patients had a complete response to surgery and chemotherapy prior to radiotherapy. Five-year actuarial rates of local control, progression-free survival, and overall survival were 84%, 40%, and 45%, respectively. Among 26 patients who relapsed, 1 failed only at the primary site, 22 developed distant metastases exclusively, and 3 had both local and distant failures. There were no acute complications of radiotherapy.
Hyperfractionated radiotherapy to 21 Gy, in conjunction with dose-intensive systemic therapy and aggressive surgical resection, is well tolerated and is associated with durable local control for most patients with Stage 4 neuroblastoma.
International Journal of Radiation OncologyBiologyPhysics 04/2000; 46(4):969-74. · 4.11 Impact Factor
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ABSTRACT: The present study evaluated the ability of the anti-GD2 ganglioside monoclonal antibody 3F8 to target tumor sites in patients with small-cell lung cancer (SCLC). Of 12 patients entered into the trial, ten received intravenous 3F8 labeled with 2 or 10 mCi iodine-131. The first five patients had recurrent or progressive disease after chemotherapy. Subsequent patients were studied before starting chemotherapy. Radionuclide scans were performed on days 1, 2, and 3 post-infusion and once between day 5 and day 7. Four patients underwent single-photon emission tomography (SPET) imaging. Radionuclide scans demonstrated localization to all known sites of disease, other than small brain metastases in one patient. SPET/CT scan fusion images confirmed precise localization. No significant toxicity was observed. Mean serum half-life was 64.2 h. Analysis of specimens from one patient who died of unrelated causes 6 days post-infusion confirmed the scan results. The present study demonstrates that 3F8 targets SCLC sites in patients. Further studies of anti-GD2 antibodies with higher doses of antibody and radionuclide are warranted to evaluate their role in SCLC.
European Journal of Nuclear Medicine 03/1996; 23(2):145-9.
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Journal of Clinical Oncology 05/1992; 10(4):671-2. · 18.37 Impact Factor
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ABSTRACT: We examined the efficacy of five commonly used drugs, teniposide (VM26), cisplatin (CDDP), cyclophosphamide (CPM), doxorubicin (DOXO), and vincristine (VCR) in a retrospective analysis of 44 clinical trials of induction chemotherapy for stage IV neuroblastoma patients newly diagnosed at older than 1 year of age. Dose intensity (DI) of each drug was calculated as milligrams per square meter per week. Linear regression analyses showed that the Dls of VM26 and CDDP had the greatest influence on clinical outcomes (ie, proportion of major response, median survival, and median progression-free survival [PFS]), while those of CPM and DOXO were less significant. VCR had no influence on the three clinical end points. Although many protocols extended treatment to more than 1 year, none of these end points correlated positively with the duration of therapy. Twenty-one weeks appeared adequate for achieving superior response, median survival, and median PFS. These results suggest that maximal dose intensification of selective drugs over a short duration may improve the outcome of patients with poor-risk neuroblastoma.
Journal of Clinical Oncology 07/1991; 9(6):1050-8. · 18.37 Impact Factor
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Progress in clinical and biological research 02/1988; 271:249-62.
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ABSTRACT: A quantitative enzyme-linked immunosorbent assay (ELISA) for honeybee venom-specific IgG is reported. This ELISA surmounts the problem of poor reproducibility due to nonparallelism of dilution curves in previously reported ELISAs. The assay is performed in polyvinyl "U" microtiter plates in which HBV is physically adsorbed to the wells. The antigen is sequentially overlaid with human serum albumin, unknown serum diluted in 10% normal goat serum (NGS), and peroxidase-labeled anti-human IgG in NGS. o-Phenylenediamine is used a substrate. The addition of stabilizing protein (NGS) is shown to be crucial in producing parallel dilution curves in this heterogeneous antigen-antibody system. Sensitivity is at or below 1 ng/ml. Coefficient of variation (using a midrange serum) is 12.1% for triplicate wells, 15.5% for sequential dilution, and 15.0% for six entirely separate assays. The assay correlates well with other methods, notably with the Staphylococcus aureus protein A solid-phase radioimmunoassay (r = 0.976).
Journal of Allergy and Clinical Immunology 10/1982; 70(3):191-8. · 11.00 Impact Factor
