Treatment, response, and toxicity:
All patients in the study received modified BFM-90 chemotherapy
per-protocol. In the limited stage disease, all except two stage-1
patients (patient-4 and patient-13) received the re-intensification
phase. Almost all patients (20/21) had baseline staging assessment by
PET-CT, of which, 14 patients (3 Stage-I, 3 Stage-II, 7 Stage III, 1
Stage IV) had a post-phase I induction response assessment by PET/CT.
Rest 7/21 (3 Stage-I, 2 Stage III, 2 Stage IV) underwent interim
assessment by non-functional imaging modalities. At the end of phase I
induction (D35), 15/21(71%) patients achieved a CR, and 6/21(29%) had
PR. After completion of induction phase II (Day 64), 19/21(90%)
patients achieved CR, and 2/21 (10%) had residual disease. A stage-IV,
CNS-3 patient (patient-8) with residual testicular disease post-phase II
induction was given testicular irradiation (24Gy) besides cranial
irradiation (18Gy). Two stage-III patients (patient-1 and patient-20)
with bony primary who had only partial response post-induction phase I
and II received irradiation to their residual bony lesion (55.6Gy and
45Gy, respectively). The toxicities resulting in hospital admission were
noted during the study period. Eight patients had a total of 15 FN
episodes. Other toxicities included recurrent urinary tract infection in
a child with paraspinal mass and bladder dysfunction, uncomplicated
dengue fever, probable fungal pneumonia. One patient had a transient
ischemic attack (TIA) as a complication of high dose methotrexate
infusion (Patient-6). In the whole cohort, there was one toxic death in
remission secondary to culture-negative severe septicemia during the
re-intensification phase (Patient-6).