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Outcome Related to Age and Stage Background. Infants (age 0-11 months) with disseminated neuroblastoma are known to have a better prognosis than older children with the disease, but there is little information regarding factors that influence the outcome of the disease in these patients. Methods. The authors report a series of 110 infants with disseminated neuroblastoma with disease diagnosed between March 1976 and February 1991 in 21 institutions participating in the Italian Cooperative Group on Neuroblastoma (ICGNB). Of the 110 infants, 34 had Stage IV disease, and 76 had Stage IV-S disease. Results. The 5-year survival probability was 77% for all patients, 71% for those with Stage IV disease, and 81% for those with Stage IV-S disease. Of the 34 infants with Stage IV disease, the 9 who were 5 months or younger at the time of disease diagnosis are all alive (1 with active disease) at 7-143 months after diagnosis, whereas of the 25 infants who were 6-11 months of age at the time of disease diagnosis, 10 have died. Of the 76 infants with Stage IV-S disease, 12/64 who were 5 months of age or younger at the time of disease diagnosis died (mostly of massive hepatomegaly); 9 of these deaths occurred in infants with disease diagnosed before they were 2 months old, whereas 1 death occurred in the 12 infants with disease diagnosed when they were 6-11 months old. Four infants with Stage IV-S disease achieved complete disease remission and subsequently had relapse of disease. High levels of serum LDH and low urinary excretion of vanillylmandelic acid were associated with worse prognosis. Conclusions. The authors suggest that infants older than 6 months of age who have Stage IV disease require aggressive therapy. For infants with disease diagnosed before they are 2 months old, Stage IV-S disease may have a worse prognosis than Stage IV disease.

Benzylguanidine is a chemical selectively taken up by cells of the sympathetic nervous system. This guanethidine derivative can be labelled with radioactive iodine, and both the 131-I and 123-I radioisotopes of iodine have been used in scintigraphic studies. In such studies, the selective uptake of the radioactive iodobenzylguanidine can be visualized using scintillation detectors. This technique has been used to image tumors such as pheochromocytoma, medullary thyroid carcinoma, paraganglioma, and neuroblastoma. The same selective uptake might be exploited in a therapeutic capacity as well. If the tumors take up a small dose of radioactive tracer for imaging, they might take up a larger dose of radioactive compound which might serve as a direct source of radiotherapy within the cancer itself. This technique was evaluated in the treatment of 31 children with advance neuroblastoma. All 31 patients had tumors that were visible on scintigraphy, indicating that their tumors took up the radioactive compound. All 31 patients had either failed to respond to conventional therapy or relapsed after conventional therapy. The children were given doses of radioactive I-131 meta-iodobenzylguanidine ranging from 2.8 to 6.0 gigaBecquerels (a gigaBecquerel is radioactivity at a level of one billion radioactive disintegrations per second). Two complete and four partial response were observed. These patients relapsed and all 31 patients are either dead or alive with disease. (Consumer Summary produced by Reliance Medical Information, Inc.)