Aspectos Clínicos, Epidemiológicos E Sobrevida De Crianças Com Neuroblastoma: 21 Anos De Experiência Do Instituto De Oncologia Pediátrica, São Paulo

Abstract

Objective: To describe the clinical and epidemiological characteristics and survival outcomes of children with neuroblastoma (NB) treated at a pediatric oncology center from 1991 to 2012.Methods: A retrospective study with clinical and epidemiological data from 258 patients with neuroblastoma treated at a pediatric oncology center from 1991 to 2012, using medical records. Results: The average age of the children at diagnosis was 40.5±46.4 months with a median age of 28.9 months (interquartile range 42.2). The male:female ratio was 1.3:1, and 1% of the patients were asymptomatic. The most frequent manifestations were: fever (25%), abdominal pain (22%), abdominal mass (19%), and bone pain (19%). The mean time from symptom onset to diagnosis was 3.0±4.8 months. The most common location of the tumor was the abdomen (63%). Metastases occurred in the bone marrow (37%) and in the bone (33%). Overall survival (OS) and event-free survival (EFS) in five years were 62 and 52%, respectively. The main cause of death was the progression of the disease (72%).Conclusions: The clinical features of children with neuroblastoma are variable and mostly nonspecific, which makes clinical recognition difficult and, in general, too late. In children less than 5 years old, with an abdominal mass and/or bone pain, irritability, and a fever from an unknown cause, neuroblastoma should be considered as a possible diagnosis.

The Use of 18f-Fdg in Oncology and its Applications in Neuroblastomas

“…The annual incidence is 10.5 per million children under the age of 15, with about 700 new cases per year in the United States. In Brazil, in a study based on the analysis of the population registry of cancer, which included 12 cities and the Federal District, the incidence of Neuroblastoma was 5.9 per million inhabitants under the age of 15 years, however studies that include registration nationwide for definitive conclusions [1]. Neuroblastoma occurs more commonly in children under 5 years of age, with a small predominance in males, and can be located anywhere along the chain of sympathetic ganglia, such as the paravertebral and posterior mediastina regions, but mainly in the medullary region of the adrenal gland.…”

“…. This embryonic tumor, derived from precursor cells of the sympathetic nervous system, considered an important challenge for health professionals, as it is associated with 15% of mortality related to pediatric oncology [1].…”

“…The diagnosis of NB was performed by means of biopsy and anatomopathological examination, or by studying the bone marrow infiltrated by the tumor associated with the presence of catecholamine metabolites in the urine, according to international criteria.1,11 The patients were staged, according to the criteria of the International Staging System for Neuroblastoma (INSS) [5], in stages 1, 2, 3, 4 and 4S (Table 1). The World Health Organization (WHO) histological classification was used [1].…”

“…Neuroblastoma is a malignant tumor most common in childhood; it is diagnosed in the vast majority of times in the first years of life up to about 5 years of age, being in most cases children of the male. The main signs and symptoms that are usually late are specific and resemble other childhood diseases, making early diagnosis difficult for health professionals [1]. Neuroblastoma originates in primitive forms of nerve cells (usually found in the embryo or fetus) of the sympathetic nervous system, which, in turn, is part of the autonomic nervous system, which controls functions such as breathing, blood pressure, heartbeat and digestion .…”

“…This tumor considered an important challenge for health professionals because it accounts for 15% of the mortality rate when related to pediatric oncology. It is worth mentioning that, since neuroblastoma is a tumor of predominant childhood incidence, occurring in more than 90% of cases in children under 10 years of age, the clinical management of these patients and the development of therapeutic protocols are not part of the daily practice of adult oncologists [1]. The FDG-PET known as a very useful imaging modality in the field of clinical oncology.…”