Neuroblastoma medical therapy
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Risk calculators and risk factors for Neuroblastoma medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]Haytham Allaham, M.D. [3]
Overview
Medical Therapy
Risk Stratification
- Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients.
- Low risk neuroblastoma patients are usually managed by either observation or surgical resection of the tumor.
- Intermediate risk neuroblastoma patients are usually managed by neoadjuvant chemotherapy in advance of a definitive surgical resection.
- High risk neuroblastoma patients are usually managed by a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, differentiation therapy, immunotherapy, and isotretinoin.[1]
- The algorithm below summarizes the management approach for neuroblastoma patients:
Children's Oncology Group risk stratification | |||||||||||||||||||||||||||||
Low risk patients | Intermediate risk patients | High risk patients | |||||||||||||||||||||||||||
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Management of Low Risk Neuroblastoma Patients[1]
Observation
- Low risk neuroblastoma patients younger than 6 months of age may be safely observed without obtaining a definitive histologic diagnosis or performing any surgical intervention.
- Observation among such patients avoids potential surgical complications, as the majority of neuroblastomas occurring among this age group demonstrate spontaneous regression.
Radiotherapy
- Radiotherapy is generally not recommended for the management of low risk neuroblastoma patients.
Chemotherapy
- Indications for chemotherapy for the management of low risk neuroblastoma patients include:
- Stage 1 or stage 2 tumors associated with MYCN amplification
- Patients older than 18 months of age presenting with a stage 2B tumor and an unfavorable histology
- Symptomatic patients due to spinal cord compression, respiratory compromise, or hepatic infiltration
- Chemotherapeutic regimens recommended for the management of low risk neuroblastoma patients may include agents such as:
Management of Intermediate Risk Neuroblastoma Patients[1]
Observation
- Observation is generally not recommended for the management of intermediate risk neuroblastoma patients.
Radiotherapy
- Indications for radiotherapy for the management of intermediate risk neuroblastoma patients include:
- Symptomatic life-threatening neuroblastoma refractory to chemotherapy and/or surgery
- Rapidly growing neuroblastoma associated with progressive disease symptoms
Chemotherapy
- Chemotherapeutic agents are generally effective for the management of intermediate risk neuroblastoma patients.
- Intermediate risk neuroblastoma patients with favorable histology are successfully managed by 4 cycles of chemotherapy following surgery.
- Intermediate risk neuroblastoma patients with unfavorable histology are successfully managed by 8 cycles of chemotherapy following surgery.
- Neoadjuvant chemotherapy may be used to facilitate the partial resection of previously unresectable neuroblastomas among intermediate risk patients.
- Chemotherapeutic regimens recommended for the management of intermediate risk neuroblastoma patients may include agents such as:
Management of High Risk Neuroblastoma Patients[1]
Observation
- Observation is generally not recommended for the management of high risk neuroblastoma patients.
Radiotherapy
- Radiation therapy to consolidate local control after surgical resection is recommended for the management of high risk neuroblastoma patients.
Chemotherapy
- Chemotherapy for high risk neuroblastoma patients is divided into the following three phases:
- Induction therapy:
- Chemotherapeutic regimens used in the induction therapy may include:
- Consolidation therapy:
- Consolidation therapy of high risk neuroblastoma patients consists of high dose chemotherapeutic agents administered in tandem with hematopoietic stem cell transplantation.
- Chemotherapeutic regimens used in the consolidation therapy may include:
- Carboplatin
- Etoposide
- Melphalan
- Busulfan
- Vincristine
- Irinotecan
- Maintenance therapy:
- A combination of differentiation therapy (GM-CSF and IL-2), isotretinoin, and immunotherapy (chimeric anti-GD2 antibody-ch14.18) are adminstered following hematopoietic stem cell transplantation to improve the survival of high risk neuroblastoma patients.
References
- ↑ 1.0 1.1 1.2 1.3 Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015