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Proposed classification of neuroblastoma
7 64
Letters to the editor
The Journal o[ Pediatrics November 1967
the deaths of American children under the age of 5. s This may be considered a challenge. .JAMES R. H U G H E S ~ DINEStt
Ivf.D., A N D
P. SINI-IA~ M,B.B.S,
D E P A R T M E N T OF BACTERIOLOGY AND I M M U N O L O G Y HARVARD MEDICAL S C H O O L 95
SHATTUCK
ST.
BOSTON, MASS. 02115 REFERENCES 1. Simon, G., and Jordan, W. S., Jr.: Infectious and allergic aspects of bronchiolitis, J. PEDIAT. 70: 533, 1967.
2. Collier, A. M., Connor, J. D., and Nyhan, W. L.: Systemic infection with Hemophilus influenzae in very young infants, J. PEDIAT. 70: 539, 1967. 3. Hughes, J. R., Bose, S. K., Kloen% W., Sinha, D. P., and Cooper, M. R.: Acute lower respiratory tract infections in Calcutta children. Indian Pediat. 3: 201, 1966. 4. Fothergill, L. D., and Wright, J.: Influenzal meningitis. The relation of age incidence to the bactericidaI power of bIood against causal organism, J. Immunol. 24: 273, 1933. 5. U. S. Department of Health, Education, and Welfare. Public Health Service. Vital statistics of the United States, 1964. U.S. Government Printing Office, Washington, D. C., 1966.
Proposed classification of neu~vblastoma
To the Editor: It is generally agreed that the prognosis of neuroblastoma in childhood is affected by the age of the patient, the presence or absence of skeletal metastases, and the degree of differentiation of the tumor cells? There is, however, little agreement concerning the management of this childhood malignancy except in those rare instances in which the tumor is well localized and easily resectable. With the advent of the newer cancer chemotherapeutic agents efforts are being made by cooperative groups ~~ and by individual institutions3, 4 to develop better methods of treatment of neurobtastoma. Comparison of the results of these efforts has been hampered, however, by the fact that there has been no uniform classification of the tumor according to the extent of its involvement. In order to make it possible for data from different institutions or cooperative groups to be more readily compared with that of others, I would like to propose the following classification of childhood neuroblastoma: Stage I, localized--resectable Stage II, regional--nnresectable Stage II!, generalized--without bone or bone marrow involvement
Stage IV, generalized--with bone or bone marrow involvement Although this classification omits any mention of the hlstological appearance of the tumor and does not take into consideration the degree of bone or bone-marrow involvement, I believe it would be a very useful and practical method for categorizing this common childhood malignancy. DAVID H .
JA_%IES~ JR.~ M,D.
ASSISTANT
PROFESSOR
OF PEDIATRICS
U N I V E R S I T Y OF T E N N E S S E E MEDICAL
SCHOOL
M EM PI-tlS ~ T E N N .
1. 2.
3.
4.
REFERENCES Sutow, W. W.: Prognosis in neuroblastoma of childhood, J. Dis. Child. 96" 299, 1958. Thurman, W. G., Fernbach, D. J., and Sullivan, 1VL P.: Cyclophosphamide therapy in childhood neuroblastoma, New England J. Med. 270: 1336, 1964. Kontras, S. B., and Newton, W. A., Jr.: Cyclophosphamide therapy of childhood neuroblastoma: Preliminary report, Cancer Chemother~p. Rep. 12: 39, 1961. James, D. H., Jr., Hustu, O., Wrenn, E. L., Jr., and Pinkel, D.: Combination chemotherapy of childhood neuroblastoma, J. A. M. A. 194: 123, 1965.
Letters to the editor
The Journal o[ Pediatrics November 1967
the deaths of American children under the age of 5. s This may be considered a challenge. .JAMES R. H U G H E S ~ DINEStt
Ivf.D., A N D
P. SINI-IA~ M,B.B.S,
D E P A R T M E N T OF BACTERIOLOGY AND I M M U N O L O G Y HARVARD MEDICAL S C H O O L 95
SHATTUCK
ST.
BOSTON, MASS. 02115 REFERENCES 1. Simon, G., and Jordan, W. S., Jr.: Infectious and allergic aspects of bronchiolitis, J. PEDIAT. 70: 533, 1967.
2. Collier, A. M., Connor, J. D., and Nyhan, W. L.: Systemic infection with Hemophilus influenzae in very young infants, J. PEDIAT. 70: 539, 1967. 3. Hughes, J. R., Bose, S. K., Kloen% W., Sinha, D. P., and Cooper, M. R.: Acute lower respiratory tract infections in Calcutta children. Indian Pediat. 3: 201, 1966. 4. Fothergill, L. D., and Wright, J.: Influenzal meningitis. The relation of age incidence to the bactericidaI power of bIood against causal organism, J. Immunol. 24: 273, 1933. 5. U. S. Department of Health, Education, and Welfare. Public Health Service. Vital statistics of the United States, 1964. U.S. Government Printing Office, Washington, D. C., 1966.
Proposed classification of neu~vblastoma
To the Editor: It is generally agreed that the prognosis of neuroblastoma in childhood is affected by the age of the patient, the presence or absence of skeletal metastases, and the degree of differentiation of the tumor cells? There is, however, little agreement concerning the management of this childhood malignancy except in those rare instances in which the tumor is well localized and easily resectable. With the advent of the newer cancer chemotherapeutic agents efforts are being made by cooperative groups ~~ and by individual institutions3, 4 to develop better methods of treatment of neurobtastoma. Comparison of the results of these efforts has been hampered, however, by the fact that there has been no uniform classification of the tumor according to the extent of its involvement. In order to make it possible for data from different institutions or cooperative groups to be more readily compared with that of others, I would like to propose the following classification of childhood neuroblastoma: Stage I, localized--resectable Stage II, regional--nnresectable Stage II!, generalized--without bone or bone marrow involvement
Stage IV, generalized--with bone or bone marrow involvement Although this classification omits any mention of the hlstological appearance of the tumor and does not take into consideration the degree of bone or bone-marrow involvement, I believe it would be a very useful and practical method for categorizing this common childhood malignancy. DAVID H .
JA_%IES~ JR.~ M,D.
ASSISTANT
PROFESSOR
OF PEDIATRICS
U N I V E R S I T Y OF T E N N E S S E E MEDICAL
SCHOOL
M EM PI-tlS ~ T E N N .
1. 2.
3.
4.
REFERENCES Sutow, W. W.: Prognosis in neuroblastoma of childhood, J. Dis. Child. 96" 299, 1958. Thurman, W. G., Fernbach, D. J., and Sullivan, 1VL P.: Cyclophosphamide therapy in childhood neuroblastoma, New England J. Med. 270: 1336, 1964. Kontras, S. B., and Newton, W. A., Jr.: Cyclophosphamide therapy of childhood neuroblastoma: Preliminary report, Cancer Chemother~p. Rep. 12: 39, 1961. James, D. H., Jr., Hustu, O., Wrenn, E. L., Jr., and Pinkel, D.: Combination chemotherapy of childhood neuroblastoma, J. A. M. A. 194: 123, 1965.