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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT01728155
Additional trial details provided through ANZCTR are available at the end of this record.
Registration number
NCT01728155
Ethics application status
Date submitted
13/11/2012
Date registered
16/11/2012
Titles & IDs
Public title
European Low and Intermediate Risk Neuroblastoma Protocol
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Scientific title
European Low and Intermediate Risk Neuroblastoma Protocol
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Secondary ID [1]
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LINES
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
LOW AND INTERMEDIATE PAEDIATRIC NEUROBLASTOMA AND NEONATAL SUPRARENAL MASSES
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Condition category
Condition code
Cancer
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Neuroendocrine tumour (NET)
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Cancer
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0
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Children's - Other
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
No intervention: Group1 - initial observation (chemotherapy is only given if there is subsequent progression)
Active comparator: Group 1: chemotherapy - chemotherapy and surgery
Experimental: Group 2 - chemotherapy and surgery
Experimental: Group 3 - chemotherapy and surgery
No intervention: Group 4 - Observation
Experimental: Group 5 - chemotherapy
Experimental: Group 6 - chemotherapy and surgery
Experimental: Group 7 - chemotherapy and surgery
Experimental: Group 8 - chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
Experimental: Group 9 - chemotherapy, surgery, radiotherapy and 13 cis-retinoic acid
Experimental: Group 10 - chemotherapy, surgery,
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Primary aim for Low Risk Neuroblastoma
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Assessment method [1]
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To demonstrate through a randomisation between observation and chemotherapy that you can safely reduce treatment in a subgroup of L2 low risk patients (those without life threatening symptoms (LTS) and without any segmental chromosomal changes (SCA), i.e. study group 1) by giving less treatment than has been given historically while maintaining an excellent OS of 100%.
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Timepoint [1]
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2 years
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Primary outcome [2]
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Primary aim for Intermediate Risk Neuroblastoma
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Assessment method [2]
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To improve the EFS to 70% with an OS of 90% of INRG stage L2 patients over the age of 18 months, with poorly differentiated or undifferentiated tumour histology (INPC criteria), by the addition of radiotherapy and 13-cis RA compared to historical conventional treatment (study group 8).
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Timepoint [2]
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2 years
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Primary outcome [3]
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Primary Aim for Neonatal Suprarenal Masses
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Assessment method [3]
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To maintain a 3-year event free survival over 80% with a non-operative therapeutic approach (serial monitoring, surgery if warranted) in infants with a localised suprarenal mass discovered ante or neonatally.
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Timepoint [3]
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3 year
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Secondary outcome [1]
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To maintain a 2 year EFS of at least 90% and an OS of at least 95% in L2 patients with LTS without SCA (study group 2)
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Assessment method [1]
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Timepoint [1]
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2 year
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Secondary outcome [2]
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To maintain the 2 year EFS of 85% and an OS of at least 98% in Ms patients without SCA (study groups 4 and 5)
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Assessment method [2]
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Timepoint [2]
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2 year
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Secondary outcome [3]
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To improve the 2 year EFS to at least 90% and maintain the OS of close to 100% in L2 patients with SCA (Study Group 3) and improve the 2 year EFS to over 70% in Ms patients with SCA (study group 6)
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Assessment method [3]
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0
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Timepoint [3]
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2 year
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Secondary outcome [4]
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To evaluate adherence to the protocol recommendations regarding LTS
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Assessment method [4]
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0
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Timepoint [4]
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5 years
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Secondary outcome [5]
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To reduce surgical morbidity by promoting strict adherence to Image Defined-Risk Factors (IDRFs) to determine surgical resectability
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Assessment method [5]
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Timepoint [5]
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5 year
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Secondary outcome [6]
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To define the long term follow-up and natural history of the Stage L2 non-resected masses that have remained IDRF positive at the end of treatment (study groups 1-3).
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Assessment method [6]
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0
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Timepoint [6]
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5 year
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Secondary outcome [7]
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To confirm in a larger patient cohort the excellent OS of 95% in stage M neuroblastoma without MYCN amplification, less than 12 months of age, when treated with moderate therapy (study group 10).
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Assessment method [7]
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Timepoint [7]
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3 year
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Secondary outcome [8]
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Maintain the results of 3yr-EFS of 90% and 3yr-OS of 100% in stage L2 patients over the age of 18 months, with differentiating neuroblastoma or differentiating ganglioneuroblastoma nodular, despite a treatment reduction (group7)
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Assessment method [8]
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0
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Timepoint [8]
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0
3 year
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Secondary outcome [9]
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To improve the 3 year EFS to at least 50% and the 3 year OS to 80% in INSS stage I patients with MYCN amplified neuroblastoma by the addition of adjuvant treatment (study group 9).
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Assessment method [9]
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0
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Timepoint [9]
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3 year
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Secondary outcome [10]
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To evaluate the impact of the tumour genomic profile on patient outcome, in order to consider its role in the treatment stratification of these intermediate risk patients (all study groups).
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Assessment method [10]
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0
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Timepoint [10]
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5 years
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Secondary outcome [11]
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To manage infants with suprarenal masses discovered ante or neonatally with a uniform approach in Europe in a multicentre setting.
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Assessment method [11]
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0
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Timepoint [11]
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5 years
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Secondary outcome [12]
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To maintain an excellent overall survival with a non-operative therapeutic approach (serial monitoring, surgery if warranted) in infants with a localised suprarenal mass discovered ante or neonatally.
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Assessment method [12]
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0
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Timepoint [12]
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3 years
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Secondary outcome [13]
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To determine the 3-year surgery-free survival in infants with suprarenal masses discovered ante or neonatally and managed conservatively (non initial surgery).
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Assessment method [13]
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0
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Timepoint [13]
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3 years
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Secondary outcome [14]
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To find out the natural history of perinatal suprarenal masses, according to the definitions set up for the study.
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Assessment method [14]
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Timepoint [14]
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5 years
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Secondary outcome [15]
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To study the kinetics of regression in those suspected suprarenal neuroblastomas in infants with suprarenal masses discovered ante or neonatally and managed conservatively (non initial surgery).
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Assessment method [15]
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Timepoint [15]
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5 years
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Secondary outcome [16]
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To collect tissue from those suprarenal masses excised in order to perform standard and investigational pathological and biological studies (INPC, MYCN, 1p, 11).
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Assessment method [16]
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Timepoint [16]
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5 years
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Secondary outcome [17]
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To collect frozen plasma from all patients included in the study in order to perform research.
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Assessment method [17]
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Timepoint [17]
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5 years
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Eligibility
Key inclusion criteria
1. LOW RISK STUDY
Inclusion criteria for the whole low risk group:
* informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
* Biopsy proven neuroblastoma
* Tumour genomic profile obtained in a NRL according to guidelines
* MYCN non-amplified
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Minimum age
90
Days
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Maximum age
18
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria for the whole low risk group:
* Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed INRG Stage L2
Inclusion criteria:
*age = 18 months
Exclusion criteria:
* any metastatic site
* MYCN amplification
* age > 18 months INRG Stage Ms
Inclusion criteria:
* age = 12 months
Exclusion criteria:
* bone, pleura/lung and/or CNS metastasis
* MYCN amplification
* age > 12 months
2. INTERMEDIATE RISK STUDY
Inclusion criteria for the whole intermediate risk group:
* informed consent and follow-up warranted; group assignment completed within 6 weeks from diagnosis; no prior chemotherapy or radiotherapy
* Tumour material available for biological studies according to guidelines
* Biopsy proven neuroblastoma confirmed in a National Reference Laboratory (NRL)
Exclusion criteria for the whole intermediate risk group:
* Diagnosis of ganglioneuroma or ganglioneuroblastoma intermixed
INRG Stage L1 and INSS stage 1:
Inclusion criteria:
* MYCN amplified
Exclusion criteria:
* MYCN non-amplified
* INSS stages 2, 3, 4, 4s
INRG Stage L2:
Inclusion criteria:
* Histology: differentiating, poorly differentiated, undifferentiated neuroblastoma or ganglioneuroblastoma nodular
* MYCN non-amplified
* age >18 months
Exclusion criteria:
* neuroblastoma NOS
* MYCN amplification.
* age = 18 months
INRG Stage M:
Inclusion criteria:
* Any histology
* MYCN non-amplified
* age = 12 months
Exclusion criteria:
* MYCN amplification
* age > 12 months
3. NEONATAL SUPRARENAL MASSES
Inclusion criteria:
* Age less than or equal to 90 days when the suprarenal mass is discovered.
* Suprarenal mass detected by ultrasound and/or MRI. The suprarenal mass may be cystic and/or solid, but IT CANNOT REACH THE MIDLINE AND should MEASURE = 5 CM AT THE LARGEST DIAMETER.
* No regional involvement: MRI scan does not show evidence of positive ipsi/contralateral lymph nodes or other spread outside the suprarenal gland.
* No metastatic involvement.
* Frozen plasma available.
* Informed consent.
* Availability to do the adequate follow-up
Exclusion criteria:
* Age older than 90 days.
* Suprarenal mass bigger than 5 cm.
* Regional involvement.
* Metastatic involvement.
* Inability to undertake mandatory diagnostic studies (biological markers, US, MRI, MIBG).
* Follow-up not guaranteed by parents/guardians.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/01/2011
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
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Accrual to date
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Final
685
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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Monash Children's Hospital - Clayton
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Recruitment hospital [2]
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Perth Children's Hospital - Nedlands
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Recruitment hospital [3]
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Sydney Children's Hospital - Sydney
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Recruitment postcode(s) [1]
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- Clayton
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Recruitment postcode(s) [2]
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- Nedlands
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Recruitment postcode(s) [3]
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- Sydney
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Recruitment outside Australia
Country [1]
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Austria
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State/province [1]
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Graz
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Austria
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Innsbruck
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Austria
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Linz
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Austria
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Wien
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Belgium
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Antwerpen
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Belgium
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Bruxelles
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Belgium
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Gent
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Belgium
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Leuven
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Belgium
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Liège
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Denmark
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Aarhus
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Denmark
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Copenhagen
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Denmark
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Odense
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Israel
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Beersheba
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Israel
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Haifa
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Israel
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Petah Tikva
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Israel
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Tel aviv
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Italy
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Ancona
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Bari
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Bologna
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Brescia
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Catania
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Ferrara
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Firenze
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Modena
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Palermo
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Parma
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Pavia
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Rimini
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Roma
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San Giovanni Rotondo
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Siena
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Tricase
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Trieste
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Verona
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Bergen
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Oslo
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Norway
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Tenerife
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Albacete
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Alicante
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Almería
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Badajoz
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Jaén
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Murcia
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Málaga
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Oviedo
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Pamplona
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Spain
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San Sebastián
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Valencia
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València
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Zaragoza
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Sweden
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Göteborg
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Linköping
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Lund
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Umeå
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Uppsala
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Switzerland
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Bellinzona
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Switzerland
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Bern
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Switzerland
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Genève
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Switzerland
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Lausanne
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Lucerne
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St. Gallen
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Switzerland
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Zürich
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Funding & Sponsors
Primary sponsor type
Other
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Name
Instituto de Investigacion Sanitaria La Fe
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
The European study, LINES 2009 (Low and Intermediate Risk Neuroblastoma European Study), groups together in a single protocol the treatment of all patients with "non high risk" neuroblastoma (NB), with stratification into two groups: low risk and intermediate risk. These two separate cohorts are included in one single protocol to enable patient data from these two groups to be entered into a common database, as the current prognostic classifications determining treatment may evolve further with subsequent more detailed molecular analysis of the tumours. 1. LOW RISK STUDY The Low Risk Study is proposed in order to: * minimise the amount of treatment (chemotherapy and surgery) for all appropriate low risk patients, who in previous studies have been shown to have an excellent long-term outcome (as in the SIOPEN 99.1-2 infant neuroblastoma studies where the overall survival was greater than 97%(H. Rubie, JCO). * improve the EFS and maintain the OS (overall survival) in L2 and Ms patients with a SCA(Segmental Cromosomal Aberration) genomic profile tumour (presence of any segmental chromosomal change (SCA)) by electively treating these patients with chemotherapy despite the absence of symptoms. 2) INTERMEDIATE RISK STUDY The Intermediate Risk Study is proposed in order to: * reduce the amount of chemotherapy for differentiating histology INRG (International Neuroblastoma Risk Group) stage L2 NB and ganglioneuroblastoma nodular patients who in previous SIOPEN study have been shown to have an excellent long-term outcome; * increase the amount of treatment (radiotherapy and 13-cis-RA (13-cis-Retinoic Acid) for poorly differentiated or undifferentiated histology INRG stage L2 NB or ganglioneuroblastoma nodular patients in order to improve the EFS registered in the previous SIOPEN study; * improve the EFS (Event Free Survival) of MYCN (V-Myc myelocytomatosis viral related oncogene, NB derived ,avian )amplified INSS (International NB Staging System) stage 1 NB patients with the introduction of adjuvant treatment; * maintain the very good results obtained in previous SIOPEN study for INRG stage M infants with a moderate treatment. NEONATAL SUPRARENAL MASSES The incidence of suprarenal tumours/masses has increased in the last decade due to the expanded use of prenatal ultrasonography in routine obstetric care and in the neonatal and early infancy care. The differential diagnosis of these masses ranges from benign (adrenal haemorrhage) to malignant processes (neuroblastoma, adrenal carcinoma). Knowledge on perinatal suprarenal masses, although based on a relatively large literature, is scattered amongst studies on very few cases with no methodical approach and often short follow up. Therefore, the optimal management of these masses has not been clearly defined. Neuroblastoma at this age is an intriguing entity with a very good prognosis in most cases. The SIOPEN Group, based on their results in the first multicenter European Trial for infants with neuroblastoma (INES) and the world-wide experience provided in the literature, is launching this European surveillance study (Multi-centre, non-blinded, one armed prospective trial) for these masses. Treatment: Observation
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https://clinicaltrials.gov/study/NCT01728155
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Trial related presentations / publications
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Circulating MYCN DNA as a tumor-specific marker in neuroblastoma patients. Cancer Res. 2002 Jul 1;62(13):3646-8. Gotoh T, Hosoi H, Iehara T, Kuwahara Y, Osone S, Tsuchiya K, Ohira M, Nakagawara A, Kuroda H, Sugimoto T. Prediction of MYCN amplification in neuroblastoma using serum DNA and real-time quantitative polymerase chain reaction. J Clin Oncol. 2005 Aug 1;23(22):5205-10. doi: 10.1200/JCO.2005.02.014. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000 Feb 2;92(3):205-16. doi: 10.1093/jnci/92.3.205. Ambros PF, Ambros IM, Kerbl R, Luegmayr A, Rumpler S, Ladenstein R, Amann G, Kovar H, Horcher E, De Bernardi B, Michon J, Gadner H. Intratumoural heterogeneity of 1p deletions and MYCN amplification in neuroblastomas. Med Pediatr Oncol. 2001 Jan;36(1):1-4. doi: 10.1002/1096-911X(20010101)36:13.0.CO;2-L. Stark DD, Moss AA, Brasch RC, deLorimier AA, Albin AR, London DA, Gooding CA. Neuroblastoma: diagnostic imaging and staging. Radiology. 1983 Jul;148(1):101-5. doi: 10.1148/radiology.148.1.6856817. Brody AS, Frush DP, Huda W, Brent RL; American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics. 2007 Sep;120(3):677-82. doi: 10.1542/peds.2007-1910. Semelka RC, Armao DM, Elias J Jr, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging. 2007 May;25(5):900-9. doi: 10.1002/jmri.20895. Siegel MJ, Jaju A. MR imaging of neuroblastic masses. Magn Reson Imaging Clin N Am. 2008 Aug;16(3):499-513, vi. doi: 10.1016/j.mric.2008.04.007. Sofka CM, Semelka RC, Kelekis NL, Worawattanakul S, Chung CJ, Gold S, Fordham LA. Magnetic resonance imaging of neuroblastoma using current techniques. Magn Reson Imaging. 1999 Feb;17(2):193-8. doi: 10.1016/s0730-725x(98)00102-7. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 2002 Jul-Aug;22(4):911-34. doi: 10.1148/radiographics.22.4.g02jl15911. Brisse HJ, Aubert B. [CT exposure from pediatric MDCT: results from the 2007-2008 SFIPP/ISRN survey]. J Radiol. 2009 Feb;90(2):207-15. doi: 10.1016/s0221-0363(09)72471-0. French. Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, Farley S, Frush DP, Hernanz-Schulman M, Jaramillo D, Johnson ND, Kaste SC, Morrison G, Strauss KJ, Tuggle N. The Image Gently campaign: working together to change practice. AJR Am J Roentgenol. 2008 Feb;190(2):273-4. doi: 10.2214/AJR.07.3526. No abstract available. Boglino C, Martins AG, Ciprandi G, Sousinha M, Inserra A. Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication. Med Pediatr Oncol. 1999 May;32(5):349-52. doi: 10.1002/(sici)1096-911x(199905)32:53.0.co;2-p. Ou P, Schmit P, Layouss W, Sidi D, Bonnet D, Brunelle F. CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children. AJNR Am J Neuroradiol. 2007 Feb;28(2):216-9. Goo HW, Choi SH, Ghim T, Moon HN, Seo JJ. Whole-body MRI of paediatric malignant tumours: comparison with conventional oncological imaging methods. Pediatr Radiol. 2005 Aug;35(8):766-73. doi: 10.1007/s00247-005-1459-x. Epub 2005 Apr 28. Uhl M, Altehoefer C, Kontny U, Il'yasov K, Buchert M, Langer M. MRI-diffusion imaging of neuroblastomas: first results and correlation to histology. Eur Radiol. 2002 Sep;12(9):2335-8. doi: 10.1007/s00330-002-1310-9. Epub 2002 Mar 19. Mendichovszky IA, Marks SD, Simcock CM, Olsen OE. Gadolinium and nephrogenic systemic fibrosis: time to tighten practice. Pediatr Radiol. 2008 May;38(5):489-96; quiz 602-3. doi: 10.1007/s00247-007-0633-8. Epub 2007 Oct 18. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 Jan;45(2):228-47. doi: 10.1016/j.ejca.2008.10.026. Lumbroso J, Guermazi F, Hartmann O, Coornaert S, Rabarison Y, Lemerle J, Parmentier C. [Sensitivity and specificity of meta-iodobenzylguanidine (mIBG) scintigraphy in the evaluation of neuroblastoma: analysis of 115 cases]. Bull Cancer. 1988;75(1):97-106. French. Khafagi FA, Shapiro B, Fischer M, Sisson JC, Hutchinson R, Beierwaltes WH. Phaeochromocytoma and functioning paraganglioma in childhood and adolescence: role of iodine 131 metaiodobenzylguanidine. Eur J Nucl Med. 1991;18(3):191-8. doi: 10.1007/BF02262730. Leung A, Shapiro B, Hattner R, Kim E, de Kraker J, Ghazzar N, Hartmann O, Hoefnagel CA, Jamadar DA, Kloos R, Lizotte P, Lumbroso J, Rufini V, Shulkin BL, Sisson JC, Thein A, Troncone L. Specificity of radioiodinated MIBG for neural crest tumors in childhood. J Nucl Med. 1997 Sep;38(9):1352-7. Shapiro B, Copp JE, Sisson JC, Eyre PL, Wallis J, Beierwaltes WH. Iodine-131 metaiodobenzylguanidine for the locating of suspected pheochromocytoma: experience in 400 cases. J Nucl Med. 1985 Jun;26(6):576-85. Shulkin BL, Shapiro B. Current concepts on the diagnostic use of MIBG in children. J Nucl Med. 1998 Apr;39(4):679-88. Sisson JC, Shulkin BL. Nuclear medicine imaging of pheochromocytoma and neuroblastoma. Q J Nucl Med. 1999 Sep;43(3):217-23. Wieland DM, Wu J, Brown LE, Mangner TJ, Swanson DP, Beierwaltes WH. Radiolabeled adrenergi neuron-blocking agents: adrenomedullary imaging with [131I]iodobenzylguanidine. J Nucl Med. 1980 Apr;21(4):349-53. Khafagi FA, Shapiro B, Gross MD. The adrenal gland. In: Maisey MN, Britton KE, Gilday DL, eds. Clinical Nuclear Medicine. 2nd ed: London Chapman & Hall 1989:271-91. Wilson LM, Draper GJ. Neuroblastoma, its natural history and prognosis: a study of 487 cases. Br Med J. 1974 Aug 3;3(5926):301-7. doi: 10.1136/bmj.3.5926.301. Young JL Jr, Ries LG, Silverberg E, Horm JW, Miller RW. Cancer incidence, survival, and mortality for children younger than age 15 years. Cancer. 1986 Jul 15;58(2 Suppl):598-602. doi: 10.1002/1097-0142(19860715)58:2+3.0.co;2-c. Gelfand MJ. Meta-iodobenzylguanidine in children. Semin Nucl Med. 1993 Jul;23(3):231-42. doi: 10.1016/s0001-2998(05)80104-7. Jacobs A, Delree M, Desprechins B, Otten J, Ferster A, Jonckheer MH, Mertens J, Ham HR, Piepsz A. Consolidating the role of *I-MIBG-scintigraphy in childhood neuroblastoma: five years of clinical experience. Pediatr Radiol. 1990;20(3):157-9. doi: 10.1007/BF02012960. Lumbroso JD, Guermazi F, Hartmann O, Coornaert S, Rabarison Y, Leclere JG, Couanet D, Bayle C, Caillaud JM, Lemerle J, et al. Meta-iodobenzylguanidine (mIBG) scans in neuroblastoma: sensitivity and specificity, a review of 115 scans. Prog Clin Biol Res. 1988;271:689-705. No abstract available. Parisi MT, Greene MK, Dykes TM, Moraldo TV, Sandler ED, Hattner RS. Efficacy of metaiodobenzylguanidine as a scintigraphic agent for the detection of neuroblastoma. Invest Radiol. 1992 Oct;27(10):768-73. doi: 10.1097/00004424-199210000-00003. Perel Y, Conway J, Kletzel M, Goldman J, Weiss S, Feyler A, Cohn SL. Clinical impact and prognostic value of metaiodobenzylguanidine imaging in children with metastatic neuroblastoma. J Pediatr Hematol Oncol. 1999 Jan-Feb;21(1):13-8. doi: 10.1097/00043426-199901000-00004. Moyes J, McCready VR, Fullbrook AC. Neuroblastoma MIBG in its diagnosis and management: Springer-Verlag Berlin and Heidelberg GmbH & Co. K 1989. 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Adela Cañete, MD, PhD
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Hospital Universitari i Politècnic La Fe, Valencia, Spain
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ANZCHOG
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27-31 Wright Street, Clayton VIC 3168
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Australia
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Monash Children's Hospital
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Toby Trahair
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High Street Randwick NSW
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Australia
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Robyn Strong
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Australia
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+613 8572 2684
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Toby Trahair
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