RESUMO
Purpose: The aim of the present study is to focus on treatment outcome of different therapeutic approaches in children with neuroblastoma treated at Kasr EL-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] and its relation to various prognostic factors
Patients and Methods: This retrospective study in: eluded all children with neuroblastoma who were treated at NEMROCK from January 1991 to December 2000. Analysis of various prognostic factors mainly, age at presentation, stage of the disease, biologic variables, different treatment modalities and their impact on response rate and survival
Results: Fifty-eight cases of neuroblastoma patients were recorded among 1601 total pediatric malignant cases with rulative frequency of 3.7% of all malignancy during the years 1991 to 2000 at NEMROCK. The male to female ratio was 0.84: 1. The Mean age was 31.59 +/- 20.77 months for males and 38 +/- 31.79% months for females. 79.6% of the cases were below 5 years. The peak age of presentation was 36 months for both sexes. Stage I disease was found in 13.56% of the cases while stage IV disease was found in 52.54% of the cases. 60% of cases [41/59] had a marker study [NSE], 85.37% [35/41] of them were highly positive. Combined treatment modalities had significantly superior results compared to chemotherapy alone or surgery alone as regards. The disease-free survival [DFS] [p=0.002]. Radiotherapy alone did not affect the overall survival [OAS] or response rate [p=0.15 and =0.85 respectively]. Similarly surgery alone did not affect OAS or response rate, [p= 0.23 and 1=0.31 respectively] but affected three-year survival [p=0.023]. The type of chemotherapy protocol [OPEC/OJEC versus other combination chemotherapy] did not affect the OAS [p =0.27] or response rate [p=0.22]. However, the toxicity was higher for combined chemotherapy protocols compared to OPEC/OJEC protocol, [p=0.04]. Metaiodobenzylguanidine [MIBG] therapy did affect the OAS [p=0.006] and 2- year survival [p=0.035] but did not affect the response rate [p=0.18]. The OAS was 54.24% at 6 months and 32.2% at 12 months. Meanwhile it reached 15.25% at 18 months and 6.78% at 3 years. The mean survival time was 11.2 months. Cases younger than 1 year of age at diagnosis had longer survival than others at 36 months
Conclusion: Despite increases in the intensity of treatment of nuroblastoma with chemoradiotherapy, MIBG, surgery and its advances, even bone marrow transplantation, the prognosis of neuroblastoma is still poor. Thus new approaches for screening, early diagnosis, new drugs and follow up are needed for better outcome