The Problem Of Spontaneous Regressions Of Malignant Tumors

Abstract

A study of the natural history of neuroblastoma was based on an analysis of 58 untreated cases, and this information was used as a background to the evaluation of (1) local forms of treatment, i.e., surgery and/or radiotherapy, and (2) a systematised form of treatment, namely, massive doses of vitamin B12 with or without surgery and/or radiotherapy. The single most important prognostic factor was found to be the age at symptomatic onset of the disease, the critical division being less than or over the age of one year. This biological difference was not overt in the untreated group, which included 20 infants under 1 year. Only 1 of these survived, the sole instance of complete spontaneous regression among the 129 children in the whole series. The average period of survival among the 19 fatal cases in infancy was merely 3 months. The conventionally treated group of 25 children included 9 infants, five of whom, all without any evidence of metastases, survived. Of the four fatal cases, three showed evidence of secondary spread, and the average survival period among the fatal cases in this group was 8 1/2 months. Survival seemed to be of a high order when onset in infancy was coupled with absence of metastases. Of the vitamin B12-treated group of 46 children, 4 were not evaluated, owing to their followup period being less than 1 year. Of the 42 remaining children, 17 manifested the disease in infancy, and all of these showed clinical remission, in spite of secondary spread, except to the skeleton, in all but 4 instances. Maintained remission for periods of 1 to 8 years in 13, complete regression of tumour in a child succumbing to poliomyelitis, and temporary remission with ultimate recurrence of disease and fatal issue in 3 further cases is the score at present. The average period of survival among the 4 fatal cases with onset in infancy in this group was 19 months. Remission of tumour in the age group over 1 year was much less common; it was observed in 5 of the 25 cases so defined.