[Management strategy in neuroblastoma]

Neuroblastoma is one of the most common (7-10%) childhood cancers and the most frequent malignancy in neonates and infants. The disease course depends not only on the child's age and clinical stage but also on other factors, especially cytogenetic and molecular abnormalities. The currently employed treatment modalities should cure at least 60% of all neuroblastoma patients. But, in a very high risk group (age >1 year, stages 2 and 3 with N-MYC amplification, all patients with stage 4), which constitutes more than half of patients, results of very intensive treatment remain still unsatisfactory. Fewer than one-third of children over one year of age with stage 4 neuroblastoma are expected to survive. The success of treatment depends not only on treatment, which intensity is tailored to the risk of individual patients, but also on detailed and precise diagnosis and therapy monitoring. Children with neuroblastoma, regardless of the presenting signs and age, should undergo comprehensive evaluation, including genetics and molecular studies. Majority of infants with neuroblastoma have a good prognosis, but choice of therapy in these patients depends on disease stage, critical organ function (Philadelphia score), surgical treatment possibilities and on the presence of the N-MYC amplification. Further improvement of therapeutic strategy, especially for advanced neuroblastoma, calls for associating individual centers in large groups, which would cooperate in completing research projects, which currently are being implemented in Europe. Novel treatment modalities should improve the treatment results in the high risk group, as well as decrease the late side-effects number in all children treated for neuroblastoma.