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==Overview== | ==Overview== | ||
Children | Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients. Low risk neuroblastoma patients are usually managed with either observation or surgical resection of the tumor. Intermidiate risk neuroblastoma patients are usually managed with neoadjuvant chemotherapy in advance of a definitive surgical resection. Whereas high risk neuroblastoma patients are usually managed with a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, and immunotherapy.<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Risk Stratification=== | ===Risk Stratification=== | ||
* Children | * Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients. | ||
* Low risk neuroblastoma patients are usually managed by either observation or surgical resection of the tumor. | * Low risk neuroblastoma patients are usually managed by either observation or surgical resection of the tumor. | ||
* Intermediate risk neuroblastoma patients are usually managed by neoadjuvant chemotherapy in advance of a definitive surgical resection. | * Intermediate risk neuroblastoma patients are usually managed by neoadjuvant chemotherapy in advance of a definitive surgical resection. | ||
* High risk neuroblastoma patients are usually managed by a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, and immunotherapy. | * High risk neuroblastoma patients are usually managed by a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, and immunotherapy.<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref> | ||
* The algorithm below summarizes the management approach for neuroblastoma patients: | * The algorithm below summarizes the management approach for neuroblastoma patients: | ||
<br> | <br> | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{familytree | | | | | | Y01 | | | | | | | | Y01=<div style="width: 20em; padding:0em;">'''Children's | {{familytree | | | | | | Y01 | | | | | | | | Y01=<div style="width: 20em; padding:0em;">'''Children's Oncology Group risk stratification'''</div>}} | ||
{{familytree | | |,|-|-|-|+|-|-|-|.| | | | }} | {{familytree | | |,|-|-|-|+|-|-|-|.| | | | }} | ||
{{familytree | | X01 | | X02 | | X03 | | | |X01=<div style="width: 20em; padding:0em;">'''Low risk patients'''</div>| X02=<div style="width: 20em; padding:0em;">'''Intermediate risk patients'''</div>| X03=<div style="width: 20em; padding:0em;">'''High risk patients'''</div>}} | {{familytree | | X01 | | X02 | | X03 | | | |X01=<div style="width: 20em; padding:0em;">'''Low risk patients'''</div>| X02=<div style="width: 20em; padding:0em;">'''Intermediate risk patients'''</div>| X03=<div style="width: 20em; padding:0em;">'''High risk patients'''</div>}} | ||
| Line 23: | Line 23: | ||
*'''Radiation therapy''' | *'''Radiation therapy''' | ||
</div>|A03=<div style="width: 20em; padding:0em;text-align:left"> | </div>|A03=<div style="width: 20em; padding:0em;text-align:left"> | ||
*'''A combination of chemotherapy, surgery, stem cell transplantation, radiation therapy, immunotherapy, and isotretinoin''' | *'''A combination of chemotherapy, surgery, stem cell transplantation, radiation therapy, differentiation therapy, immunotherapy, and isotretinoin''' | ||
</div>}} | </div>}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
<br> | <br> | ||
===Management of Low Risk Neuroblastoma Patients=== | |||
===Management of Low Risk Neuroblastoma Patients<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref>=== | |||
====Observation==== | ====Observation==== | ||
* Low risk neuroblastoma patients younger than 6 months of age may be safely observed without obtaining a definitive histologic diagnosis or performing any surgical intervention. | * Low risk neuroblastoma patients younger than 6 months of age may be safely observed without obtaining a definitive histologic diagnosis or performing any surgical intervention. | ||
| Line 38: | Line 39: | ||
:* Age older than 18 months presenting with a stage 2B tumor and an unfavorable histology | :* Age older than 18 months presenting with a stage 2B tumor and an unfavorable histology | ||
:* Symptomatic patients due to spinal cord compression, respiratory compromise, and hepatic infiltration | :* Symptomatic patients due to spinal cord compression, respiratory compromise, and hepatic infiltration | ||
* Chemotherapeutic | * Chemotherapeutic regimens recommended for the management of neuroblastoma include: | ||
:* Carboplatin | :* Carboplatin | ||
:* Cyclophosphamide | :* Cyclophosphamide | ||
| Line 44: | Line 45: | ||
:* Etoposide | :* Etoposide | ||
===Management of Intermediate Risk Neuroblastoma Patients=== | ===Management of Intermediate Risk Neuroblastoma Patients<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref>=== | ||
====Observation==== | ====Observation==== | ||
* Observation is generally not recommended among intermediate risk neuroblastoma patients. | * Observation is generally not recommended among intermediate risk neuroblastoma patients. | ||
| Line 57: | Line 58: | ||
* Intermediate risk neuroblastoma patients with '''unfavorable histology''' are successfully managed by '''8''' cycles of chemotherapy following surgery. | * Intermediate risk neuroblastoma patients with '''unfavorable histology''' are successfully managed by '''8''' cycles of chemotherapy following surgery. | ||
* Neoadjuvant chemotherapy may be used to facilitate the partial resection of previously unresectable neuroblastomas among intermediate risk patients. | * Neoadjuvant chemotherapy may be used to facilitate the partial resection of previously unresectable neuroblastomas among intermediate risk patients. | ||
* Chemotherapeutic | * Chemotherapeutic regimens recommended for the management of neuroblastoma include: | ||
:* Carboplatin | :* Carboplatin | ||
:* Cyclophosphamide | :* Cyclophosphamide | ||
| Line 63: | Line 64: | ||
:* Etoposide | :* Etoposide | ||
===Management of High Risk Neuroblastoma Patients=== | ===Management of High Risk Neuroblastoma Patients<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref>=== | ||
====Observation==== | |||
* Observation is generally not recommended among high risk neuroblastoma patients. | |||
====Radiotherapy==== | |||
* Radiation therapy to consolidate local control after surgical resection is recommended for the management of high risk neuroblastoma patients. | |||
====Chemotherapy==== | ====Chemotherapy==== | ||
* Chemotherapy for high risk neuroblastoma patients is divided into the following three phases: | |||
:* '''Induction therapy:''' | |||
::* Chemotherapeutic regimens used in the induction therapy may include: | |||
:::* Cisplatin | |||
:::* Etoposide | |||
:::* Vincristine | |||
:::* Cyclophosphamide | |||
:::* Doxorubicin | |||
:::* Topotecan | |||
:* '''Consolidation therapy:''' | |||
::* Consolidation therapy of high risk neuroblastoma patients consists of high dose chemotherapeutic agents administered in tandem with hematopoietic stem cell transplantation. | |||
::* Chemotherapeutic regimens used in the consolidation therapy may include: | |||
:::* Carboplatin | |||
:::* Etoposide | |||
:::* Melphalan | |||
:::* Busulfan | |||
:::* Vincristine | |||
:::* Irinotecan | |||
:* '''Maintenance therapy:''' | |||
::* A combination of differentiation therapy (GM-CSF and IL-2), isotretinoin, and immunotherapy (chimeric anti-GD2 antibody-ch14.18) are adminstered following hematopoietic stem cell transplantation to improve the survival of high risk neuroblastoma patients. | |||
Latest revision as of 00:33, 10 October 2015
Overview
Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients. Low risk neuroblastoma patients are usually managed with either observation or surgical resection of the tumor. Intermidiate risk neuroblastoma patients are usually managed with neoadjuvant chemotherapy in advance of a definitive surgical resection. Whereas high risk neuroblastoma patients are usually managed with a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, and immunotherapy.[1]
Medical Therapy
Risk Stratification
- Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients.
- Low risk neuroblastoma patients are usually managed by either observation or surgical resection of the tumor.
- Intermediate risk neuroblastoma patients are usually managed by neoadjuvant chemotherapy in advance of a definitive surgical resection.
- High risk neuroblastoma patients are usually managed by a combination of surgery, chemotherapy, radiation therapy, hematopoietic stem cell transplantation, and immunotherapy.[1]
- The algorithm below summarizes the management approach for neuroblastoma patients:
Children's Oncology Group risk stratification | |||||||||||||||||||||||||||||
Low risk patients | Intermediate risk patients | High risk patients | |||||||||||||||||||||||||||
|
|
| |||||||||||||||||||||||||||
Management of Low Risk Neuroblastoma Patients[1]
Observation
- Low risk neuroblastoma patients younger than 6 months of age may be safely observed without obtaining a definitive histologic diagnosis or performing any surgical intervention.
- Observation among such patients avoids potential surgical complications, as the majority of neuroblastomas occurring in this age group demonstrate spontaneous regression.
Radiotherapy
- Radiotherapy is generally not recommended among low risk neuroblastoma patients.
Chemotherapy
- Indications for chemotherapy among low risk neuroblastoma patients include:
- Stage 1 or stage 2 tumors associated with MYCN amplification
- Age older than 18 months presenting with a stage 2B tumor and an unfavorable histology
- Symptomatic patients due to spinal cord compression, respiratory compromise, and hepatic infiltration
- Chemotherapeutic regimens recommended for the management of neuroblastoma include:
- Carboplatin
- Cyclophosphamide
- Doxorubicin
- Etoposide
Management of Intermediate Risk Neuroblastoma Patients[1]
Observation
- Observation is generally not recommended among intermediate risk neuroblastoma patients.
Radiotherapy
- Indications for radiotherapy among intermediate risk neuroblastoma patients include:
- Symptomatic life-threatening neuroblastoma refractory to chemotherapy and/or surgery
- Progressive rapidly growing neuroblastoma
Chemotherapy
- Chemotherapeutic agents are generally effective in the treatment of intermediate risk neuroblastoma patients.
- Intermediate risk neuroblastoma patients with favorable histology are successfully managed by 4 cycles of chemotherapy following surgery.
- Intermediate risk neuroblastoma patients with unfavorable histology are successfully managed by 8 cycles of chemotherapy following surgery.
- Neoadjuvant chemotherapy may be used to facilitate the partial resection of previously unresectable neuroblastomas among intermediate risk patients.
- Chemotherapeutic regimens recommended for the management of neuroblastoma include:
- Carboplatin
- Cyclophosphamide
- Doxorubicin
- Etoposide
Management of High Risk Neuroblastoma Patients[1]
Observation
- Observation is generally not recommended among high risk neuroblastoma patients.
Radiotherapy
- Radiation therapy to consolidate local control after surgical resection is recommended for the management of high risk neuroblastoma patients.
Chemotherapy
- Chemotherapy for high risk neuroblastoma patients is divided into the following three phases:
- Induction therapy:
- Chemotherapeutic regimens used in the induction therapy may include:
- Cisplatin
- Etoposide
- Vincristine
- Cyclophosphamide
- Doxorubicin
- Topotecan
- Consolidation therapy:
- Consolidation therapy of high risk neuroblastoma patients consists of high dose chemotherapeutic agents administered in tandem with hematopoietic stem cell transplantation.
- Chemotherapeutic regimens used in the consolidation therapy may include:
- Carboplatin
- Etoposide
- Melphalan
- Busulfan
- Vincristine
- Irinotecan
- Maintenance therapy:
- A combination of differentiation therapy (GM-CSF and IL-2), isotretinoin, and immunotherapy (chimeric anti-GD2 antibody-ch14.18) are adminstered following hematopoietic stem cell transplantation to improve the survival of high risk neuroblastoma patients.