Progressive Subtype

The vast majority of stage-4 tumors and a minor fraction of stages 1,2,3 and 4S neuroblastomas belong to the progressive subtype. Those patients are currently treated with all available therapeutic modalities (poly-chemotherapy including megatherapy with autologous stem cell transplantation, surgery, radiotherapy, im-munotherapy, differentiation therapy) to improve the still poor event-free and overall survival (Figure 7.4; also see Chap. 11). The time to progression and the sites of progression depend on the biological profile of individual tumors and the type of therapy the patient received. A more precise definition of the clinical ex tremes (pure regressive/pure progressive subtype) is probably necessary before the molecular basis for the slowly progressing neuroblastoma groups is understood.

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