Management of neuroblastoma: a study of first- and second-line chemotherapy responses, a single institution experience

Abstract

Neuroblastoma is a high-grade malignancy of childhood. It is chemo- and radio-sensitive but prone to relapse after initial remission. The aim of the current study was to study the results of the first- and second-line chemotherapy on the short-term response and long-term survival of children, and to further describe the side effects of treatment. Ninety-five children with advanced neuroblastoma were included in the study, divided into two groups according to the treatment strategy: 65 were treated by first-line chemotherapy alone, and 30 children who were not responding or relapsed after first-line chemotherapy were treated by second-line chemotherapy. External beam radiotherapy was given to bone and brain secondary cancers when detected. Staging workup was performed before, during and after management. Response was documented after surgery for the primary tumor. Median follow up was 32 months (range 24-60 months). Chemothe rapy was continued until toxicity or disease progression occurred, indicating interruption of chemotherapy. Patients received a maximum of 8 cycles. Toxicity was mainly myelo-suppression, with grade II-III severity in 60% of the firstline and 70% of the second-line chemotherapy patients. Median total actuarial survival was nearly 51 months for the first-line chemotherapy group and 30 months for the second-line line group, with a statistically significant difference between the two groups (P<0.01).

Retinoic acid induces differentiation in neuroblastoma via ROR1 by modulating retinoic acid response elements

“…The current treatments for NB include radiation therapy and chemotherapy. However, these treatments are very toxic and harmful (4). In addition, the relapse rates are markedly high, usually leading to additional chemotherapy or death (4).…”

“…However, these treatments are very toxic and harmful (4). In addition, the relapse rates are markedly high, usually leading to additional chemotherapy or death (4). A therapeutic approach that has minimized side effects is retinoic acid (RA)-induced differentiation with RA analogues such as all-trans RA.…”