During the fall of 1995, I had just turned 40 and was at the top of my legal
profession. But I suddenly found myself getting totally exhausted each weekend.
I was of no use to my wife, Ellie, or my kids.
One morning while using the treadmill, I saw stars. I drove myself to the
emergency room; the doctors there thought I was having a heart attack. But tests showed
no heart problems, so I went back to work -- I had to because I own my
business. My internist sent me to a cardiologist and other...
Added text to state that ATRX is involved in epigenetic gene silencing and telomere length; ATRX mutation without MYCN amplification is associated with age at diagnosis in adolescents and young adults with metastatic neuroblastoma (cited Cheung et al. as reference 48).
Added Schleiermacher et al. as reference 56.
Revised text to state that before resection of the primary tumor, bone should be assessed by metaiodobenzylguanidine (MIBG) scan, which is applicable to all sites of disease, and by technetium 99 scan if the results of the MIBG scan are negative or unavailable. Also added text to state that additional imaging of isolated or equivocal positive lesions is recommended if the primary tumor does not take up MIBG (cited Taggart et al. as reference 5).
Revised text for stage 4S to state that it is considered localized primary tumor, as defined for stage 1, 2A, or 2B, with dissemination limited to skin, liver, and/or bone marrow (limited to infants younger than 18 months).
Treatment Option Overview
Added text to state that the Children's Oncology Group (COG) study COG-P9641 demonstrated excellent survival in patients with asymptomatic, low-risk, stage 2A or 2B disease with favorable histology (cited Strother et al. as reference 3).
Revised text to state that for children with recurrent or refractory neuroblastoma, 131 I-MIBG is an effective palliative agent and should be considered (cited Johnson et al. as reference 19 and level of evidence 3iiiA).
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
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February 25, 2014
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