Results of induction chemotherapy in children older than 1 year with a stage 4 neuroblastoma treated with the NB 97 French Society of Pediatric Oncology (SFOP) protocol.

PURPOSE: To test the metastatic response rate in stage 4 neuroblastoma, using dose-intensive induction chemotherapy in a multi-institutional setting. PATIENTS AND METHODS: From 1998 to 1999, 47 consecutive children were treated according to N7 protocol. Children received cyclophosphamide 140 mg/kg, doxorubicin 75 mg/m(2), and vincristine 0.066 mg/kg (CAV) in cycles 1, 2, 4, and 6, and cisplatinum 200 mg/m(2) and etoposide 600 mg/m(2) (P/VP) in cycles 3, 5, and 7. The International Neuroblastoma Staging system was used with an emphasis on skeletal evaluation by 123-iodine-metaiodobenzylguanidine (MIBG) scintigraphy. A phase II study evaluating the metastasis complete response rate after induction chemotherapy was conducted in patients who had positive metastatic sites on MIBG scans at diagnosis. RESULTS: Forty-six patients were assessable for toxicity. Hematologic toxicity was the main toxicity observed. Neutropenia was more frequent after CAV than after P/VP (P < .001). A higher rate of thrombocytopenia was observed after P/VP (P = .03). Forty patients with positive MIBG were assessable for metastatic response, and complete regression of metastases was achieved in 17 patients (ie, 43%; 95% CI, 27% to 59%). Of all 47 patients, 21 achieved complete metastatic response. CONCLUSION: The N7 induction chemotherapy protocol was feasible in a multicentric setting. The observed metastasis complete response rate was similar to that obtained in our previous studies and significantly lower than that published in a previous series using the same regimen. In our hands, escalating doses of cyclophosphamide and prolonging conventional chemotherapy with the same drugs failed to improve the metastasis complete response rate.

[French validation of the revised Piper Fatigue Scale]. / Validation française de l'échelle de fatigue révisée de Piper.

The need for a valid and reliable multi-dimensional instrument in French to enable nurses and clinicians to assess intensity and changes in cancer-related fatigue (CRF) and evaluate efficacy of intervention stratégies on patient outcome, prompted us to translate the Piper Fatigue Scale (PFS) and assess its psychometric properties in a French speaking population. The revised PFS is a 22 item self-report instrument with four sub-scales: behavioural/severity, affective, sensory and cognitive/mood. The PFS was translated using a procédure of translation and back translation and tested on 20 bilingual subjects. Correlation coefficients were measured between the item scores of the English and French version of the PFS. The French version of the PFS was adjusted and then completed by 229 adult cancer patients with solid tumours under-going treatment by chemo-, radio-, hormono- or immunotherapy. A factorial analysis and a multi-traits analysis were used to assess the reliability and the dimensional structure of the translated version of the PFS. Cronbach's alpha correlations ranged between 0.85 and 0.92 for the various sub-scales, thus indicating good sub-scale reliability. Item internal consistency was good with 100% of item-scale correlations greater than or equal to 0.4. Item discriminant validity checking showed 3 items to be insufficiently discriminating. Item-scale correlations greater than the correlation of the item with other sub-scales were 98%. The Cognitive/Mood dimension appeared to group 2 separate dimensions. Convergent validity, tested by correlating the PFS with a Visual Analogue Scale measuring fatigue and with the OMS Physical Performance Status Scale, revealed significant relationships. A five sub-scale model of the PFS is proposed containing 22 items to increase performance of the French version of the PFS comparatively to the 4 sub-scale model of the original PFS. Translation of 2 items has been slightly modified to reduce ambiguity. The overall results of this preliminary study are satisfactory. We expect results to be further improved by the modifications proposed and testing is now underway in homogenous populations to evaluate the sensitivity of the instrument to changes over time. This will enable us to ascertain the definitive French version of the Piper Fatigue Scale.

Quality of life of patients treated during childhood for a bone tumor: assessment by the Child Health Questionnaire.

To determine which factors impact on quality of life of patients with bone tumor, we used the Children Health Questionnaire French version. Thirty-seven patients (25 males, 19 osteosarcoma, 18 Ewing sarcoma) were studied. At assessment, median age was 15 years, median follow-up was 4 years. Mean scores were 60, 81, 76, 74, 70, 87 for general health, physical functioning, pain, mental health, self-esteem, and family activity, respectively. Lower results were observed for mental health in girls, for physical functioning, and self-esteem in patients with endoprosthesis, and for family activity and pain in patients who had relapsed.