Treatment
IREC therapy comprised of irinotecan 100 mg/m2 (2-hour
infusion) on days 1 through 3; etoposide 100 mg/m2(2-hour infusion) on days 1 through 3; and carboplatin 80
mg/m2 (2-hour infusion) on days 1 through 3. All
patients were admitted to the hospital and underwent intravenous
hydration. Trimethoprim-sulfamethoxazole and fluconazole were
administered orally for infection prophylaxis. In patients with grade IV
neutropenia, prophylactic use of granulocyte colony-stimulating factor
(G-CSF) was allowed. Blood transfusions were administered as appropriate
with a target of hemoglobin >7 g/dL and platelet count
>20 × 109/L. Oral cefpodoxime was
administered to prevent the development of diarrhea caused by
irinotecan. IREC was administered at 4-week intervals if bone marrow
recovery (neutrophil count >0.5 × 109/L
and platelet count >100 × 109/L) was
achieved. Treatment response was assessed in all patients using the
International Neuroblastoma Response Criteria
(INRC)11.