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Management of Neuroblastoma: ICMR Consensus Document
Deepak Bansal1, Sidharth Totadri2, Girish Chinnaswamy3
1Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. deepakbansaldr@gmail.com.
Indian Journal of Pediatrics
|April 4, 2017
Summary
Neuroblastoma (NBL) is a common childhood cancer with poor outcomes for high-risk cases. This review outlines management strategies for NBL, focusing on risk stratification and treatment protocols for developing countries.
Area of Science:
- Pediatric Oncology
- Cancer Research
- Clinical Management
Background:
- Neuroblastoma (NBL) is the most frequent pediatric extracranial solid tumor.
- High-risk NBL presents significant management challenges and poor prognoses.
- NBL commonly presents at advanced stages, originating along the sympathetic chain.
Purpose of the Study:
- To provide a consensus document on neuroblastoma (NBL) management strategies.
- To address the specific challenges of NBL treatment in developing countries, including India.
- To outline risk stratification and therapeutic approaches for various NBL stages.
Main Methods:
- Diagnosis relies on tumor biopsy, elevated urinary catecholamines, and imaging (mIBG scan or FDG-PET/bone scan).
- Risk stratification incorporates age, stage, histopathology, MYCN amplification, and 11q aberration.
- Treatment protocols vary from observation and surgery for low-risk NBL to chemotherapy, stem cell transplant, and immunotherapy for high-risk NBL.
Main Results:
- Low-risk NBL (Stage 1, asymptomatic Stage 2) shows excellent prognosis with surgery alone.
- Intermediate-risk NBL (unresectable Stage 2/3, infants with Stage 4) has good outcomes with chemotherapy and surgery.
- High-risk NBL (older children, Stage 4, MYCN amplified) has suboptimal outcomes, though multimodality therapy improves survival.
Conclusions:
- Effective management of NBL requires tailored risk stratification and multimodality therapy.
- Developing countries face additional hurdles like late presentation and limited treatment facilities.
- Consensus guidelines are crucial for improving NBL outcomes globally, particularly in resource-limited settings.