Volume 9, Issue 2, June 2021, Page: 85-91
Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma
Ahmed Elhemaly, Pediatric Oncology, National Cancer Institute (NCI)-Cairo University and Children Cancer Hospital of Egypt (CCHE), Cairo, Egypt
Ahmed Fathalla, Surgical Oncology, National Cancer Institute, Cairo, Egypt
Mahmed Elhusseny, Pediatric Oncology, Children cancer Hospital of Egypt, Cairo, Egypt
Mohamed Fawzy, Pediatric Oncology, National Cancer Institute (NCI)-Cairo University and Children Cancer Hospital of Egypt (CCHE), Cairo, Egypt
Received: Mar. 13, 2021;       Accepted: Mar. 27, 2021;       Published: Apr. 7, 2021
DOI: 10.11648/j.crj.20210902.11       View        Downloads  
Abstract
Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.
Keywords
Salvage, Neuroblastoma, High Risk-Low Middle, Income Countries
To cite this article
Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy, Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma, Cancer Research Journal. Vol. 9, No. 2, 2021, pp. 85-91. doi: 10.11648/j.crj.20210902.11
Copyright
Copyright © 2021 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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