Multiply Relapsed Disease

Cure of multiply relapsed high-risk neuroblasto-ma is virtually unheard of; hence, quality of life becomes a predominant concern and toxic treatments should be avoided. Reasonable chemothera-peutic options include use of topotecan (i.v. or p.o.), irinotecan, etoposide (i.v. or p.o.), or temozolomide, singly or with other agents such as cyclophos-phamide, carboplatin, temozolomide, and/or vin-cristine - all at relatively mild dosages. Widely available cytostatic agents that warrant consideration in this setting may include retinoids, Gleevec, and thalidomide. Phase-I therapies that have expected low toxicity and may be available on an outpatient basis may be reasonable. Local radiotherapy and low-dose 131I-MIBG are useful for palliation of pain or for preventative treatment of heavily involved sites (especially skeletal) likely to become symptomatic.

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