OK just to clarify stuff cause this is probably quite new to you.
I think you are treated under SIOPEN under the SIOPEN study. The study posits all sorts of questions and comes up with answers about what is most effective.
Some examples would be:
- They recently found that adding IL2 to immunotherapy does not improve survival.
- They found that BuMel transplant regimen was more effective than CEM.
- They found that GCSF heavily reduced complications during induction chemo and added it to the protocol.
Historically, as soon as they find out that one arm is proven better than the other, they terminate experiment giving everyone the superior treatment.
Initially, I was very confused by your question cause I though you are being asked to choose between 2 protocols (COG vs SIOPEN). That would be a terrible nightmare of a choice not many could help you with.
However, in this case, you are just being asked to participate in an experiment that will hopefully improve treatment for all children.
The modified N7 protocol for induction is a 21 day cycle. The standard SIOPEN one (Rapid COJEC) is a 10 day cycle and is quite intense, your counts bottom out just as you enter you next cycle.
Recently, some papers have raised the question of the real need for such an aggressive induction chemo.
An example is:
SIOPEN are trying to answer the questions:
- Is it necessary to put patients under the stress of a rapid chemo regimen?
- Does rapid COJEC lead to better overall survival than the COG modified N7 induction (COGs protocol is heavily based off Memorial Sloan Kettering's protocol)
Nobody really has the answer here yet. With the huge complexity of high risk NB treatment there is a lot of "interplay" between drugs. This is why it is critical to keep every parameter the same in the treatment when answering these questions. (same transplant, radiation, immunotherapy)
So back to your original question. Nobody really has an answer. If you are in the test arm that gets the N7 based induction you are going to be in treatment for longer, but it will be less intense. You will have more of a chance to recover between cycles.
Long term, we don't know what this all means, but some initial research is pointing out that Rapid COJEC is not causing a measurable improvement in survival.