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Treating pediatric metastatic neuroblastoma with chemotherapy-based multimodality approach in a non-transplant setting - experience from a developing country
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  • Manjusha Nair,
  • Prasanth V R,
  • Priyakumari Thankamony,
  • Binitha Rajeswari,
  • Guruprasad C S,
  • Preethi George
Manjusha Nair
Regional Cancer Centre Thiruvananthapuram
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Prasanth V R
Regional Cancer Centre Thiruvananthapuram
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Priyakumari Thankamony
Regional Cancer Centre
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Binitha Rajeswari
Regional Cancer Centre Thiruvananthapuram
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Guruprasad C S
Regional Cancer Center
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Preethi George
Regional Cancer Centre Trivandrum
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Abstract

Background: Children with metastatic neuroblastoma have inferior survival despite therapeutic advances. Myeloablative chemotherapy followed by stem cell transplantation, accepted as the current standard of care, is not accessible to patients in many developing countries due to resource constraints. We share our experience of treating metastatic neuroblastoma in a non-transplant facility with conventional chemotherapy, surgery, and radiotherapy. Method - Retrospective study of children 1-14years of age treated for metastatic neuroblastoma in our center from January 2008 to December 2017 Results – Eighty-nine patients with metastatic neuroblastoma received treatment. Mean age was 3.5years and male:female ratio was 1.1:1. The commonest primary site was suprarenal(55%) and commonest site of metastasis was bone marrow(76%). 40% patients had multiple metastatic sites. Mean baseline LDH was 3724 U/L(range303-16609 U/L) and most(65%) patients had LDH>750U/L.53 patients(59.6%)had good response to chemotherapy as evidenced by clearance of metastatic disease, but out of them, 43 patients (81%) progressed subsequently. 26 patients underwent surgery and 12 patients received maintenance therapy. 74 patients(86%) developed recurrence and all but one died. Median time to recurrence and death were 9months(range 0-120months) and 10months(range 1-123months) respectively. At a median follow-up of 72months(range15-135months), 16 patients are alive, with 5-year disease-free survival and overall survival of 17.6% and 18.4% respectively. Age, baseline LDH, chemotherapy regimen and response to treatment affected survival. Conclusion: Outcome of non-infant metastatic neuroblastoma remains dismal in a non-transplant setting. Younger age, lower baseline LDH and good response to chemotherapy appear to confer survival advantage, and may be used for risk-stratification in developing countries.