Neuroblastoma medical therapy: Difference between revisions

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__NOTOC__
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{{Neuroblastoma}}
{{Neuroblastoma}}
{{CMG}}
{{CMG}} {{AE}}{{ZAS}}{{HL}}


==Overview==
==Overview==
Patients with neuroblastoma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, retinoid therapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, [[side effects]] are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
Children oncology group (COG) risk stratification system determines the protocol of management used for neuroblastoma [[Patient|patients]]. COG risk stratification system divides the [[Patient|patients]] into 03 groups: low risk, intermediate risk and high risk [[Patient|patients]]. Low risk neuroblastoma patients are usually managed by either [[observation]] or [[surgical resection]] of the [[tumor]]. Intermediate risk [[Patient|patients]] are managed by [[neoadjuvant therapy]] in advance of a definitive [[surgical resection]]. High risk neuroblastoma [[Patient|patients]] are usually managed by a combination of [[surgery]], [[chemotherapy]], [[radiation therapy]], [[hematopoietic stem cell transplantation]], [[immunotherapy]] and [[Isotretinoin|isotretrinoin]].


==Medical Therapy==
==Medical Therapy==
'''Risk Stratification'''<ref>{{Cite journal
| author = [[Chizuko Okamatsu]], [[Wendy B. London]], [[Arlene Naranjo]], [[Michael D. Hogarty]], [[Julie M. Gastier-Foster]], [[A. Thomas Look]], [[Michael LaQuaglia]], [[John M. Maris]], [[Susan L. Cohn]], [[Katherine K. Matthay]], [[Robert C. Seeger]], [[Tsutomu Saji]] & [[Hiroyuki Shimada]]
| title = Clinicopathological characteristics of ganglioneuroma and ganglioneuroblastoma: a report from the CCG and COG
| journal = [[Pediatric blood & cancer]]
| volume = 53
| issue = 4
| pages = 563–569
| year = 2009
| month = October
| doi = 10.1002/pbc.22106
| pmid = 19530234
}}</ref><ref>{{Cite journal
| author = [[Susan L. Cohn]], [[Andrew D. J. Pearson]], [[Wendy B. London]], [[Tom Monclair]], [[Peter F. Ambros]], [[Garrett M. Brodeur]], [[Andreas Faldum]], [[Barbara Hero]], [[Tomoko Iehara]], [[David Machin]], [[Veronique Mosseri]], [[Thorsten Simon]], [[Alberto Garaventa]], [[Victoria Castel]] & [[Katherine K. Matthay]]
| title = The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report
| journal = [[Journal of clinical oncology : official journal of the American Society of Clinical Oncology]]
| volume = 27
| issue = 2
| pages = 289–297
| year = 2009
| month = January
| doi = 10.1200/JCO.2008.16.6785
| pmid = 19047291
}}</ref><ref>{{Cite journal
| author = [[Chrystal U. Louis]] & [[Jason M. Shohet]]
| title = Neuroblastoma: molecular pathogenesis and therapy
| journal = [[Annual review of medicine]]
| volume = 66
| pages = 49–63
| year = 2015
| month =
| doi = 10.1146/annurev-med-011514-023121
| pmid = 25386934
}}</ref><ref>{{Cite journal
| author = [[Andrew M. Davidoff]]
| title = Neuroblastoma
| journal = [[Seminars in pediatric surgery]]
| volume = 21
| issue = 1
| pages = 2–14
| year = 2012
| month = February
| doi = 10.1053/j.sempedsurg.2011.10.009
| pmid = 22248965
}}</ref>
* Children Oncology Group (COG) risk stratification system determines the protocol of management used for neuroblastoma [[Patient|patients]].
* Low risk neuroblastoma [[Patient|patients]] are usually managed by either [[observation]] or [[surgical resection]] of the [[tumor]].
* Intermediate risk neuroblastoma [[Patient|patients]] are usually managed by [[neoadjuvant chemotherapy]] in advance of a definitive [[surgical resection]].
* High risk neuroblastoma [[Patient|patients]] are usually managed by a combination of [[surgery]], [[chemotherapy]], [[radiation therapy]], [[hematopoietic]] [[stem cell]] [[transplantation]], differentiation therapy, [[immunotherapy]], and [[isotretinoin]].<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 [[Patient|patients]]:
<br>
{{Family tree/start}}
{{familytree  | | | | | | Y01 | | | | | | | | Y01=<div style="width: 20em; padding:0em;">'''Children's Oncology Group risk stratification'''</div>}}
{{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|boxstyle= border-top: 0px;| | A01 | |  A02 | | A03 | | | |A01=<div style="width: 20em; padding:0em;text-align:left">
*'''[[Surgery]] followed by [[chemotherapy]]'''
*'''[[Chemotherapy]] with or without [[surgery]]'''
*'''[[Observation]] without [[biopsy]]'''
</div>|A02=<div style="width: 20em; padding:0em;text-align:left">
*'''[[Chemotherapy]] with or without [[surgery]]'''
*'''[[Surgery]] and [[observation]]'''
*'''[[Radiation therapy]]'''
</div>|A03=<div style="width: 20em; padding:0em;text-align:left">
*'''A combination of [[chemotherapy]], [[surgery]], [[stem cell transplantation]], [[radiation therapy]], differentiation therapy, [[immunotherapy]], and [[isotretinoin]]'''
</div>}}
{{Family tree/end}}
<br>


:*Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.
===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><ref>{{Cite journal
:*Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Common drugs include cyclophosphamide or ifosfamide, cisplatin or carboplatin.
| author = [[Jed G. Nuchtern]], [[Wendy B. London]], [[Carol E. Barnewolt]], [[Arlene Naranjo]], [[Patrick W. McGrady]], [[James D. Geiger]], [[Lisa Diller]], [[Mary Lou Schmidt]], [[John M. Maris]], [[Susan L. Cohn]] & [[Robert C. Shamberger]]
:*High-dose chemotherapy/radiation therapy and stem cell transplant: This type of treatment is sometimes used in children with high-risk neuroblastoma who are unlikely to be cured with other treatments.
| title = A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study
:*Retinoid therapy: This kind of treatment is thought to help some cells to differentiate into normal cells. For children with high-risk neuroblastoma, 13-cis-retinoic acid is used to reduce the risk of recurrence after high-dose chemotherapy and stem cell transplant.
| journal = [[Annals of surgery]]
| volume = 256
| issue = 4
| pages = 573–580
| year = 2012
| month = October
| doi = 10.1097/SLA.0b013e31826cbbbd
| pmid = 22964741
}}</ref><ref>{{Cite journal
| author = [[Douglas R. Strother]], [[Wendy B. London]], [[Mary Lou Schmidt]], [[Garrett M. Brodeur]], [[Hiroyuki Shimada]], [[Paul Thorner]], [[Margaret H. Collins]], [[Edward Tagge]], [[Stanton Adkins]], [[C. Patrick Reynolds]], [[Kevin Murray]], [[Robert S. Lavey]], [[Katherine K. Matthay]], [[Robert Castleberry]], [[John M. Maris]] & [[Susan L. Cohn]]
| title = Outcome after surgery alone or with restricted use of chemotherapy for patients with low-risk neuroblastoma: results of Children's Oncology Group study P9641
| journal = [[Journal of clinical oncology : official journal of the American Society of Clinical Oncology]]
| volume = 30
| issue = 15
| pages = 1842–1848
| year = 2012
| month = May
| doi = 10.1200/JCO.2011.37.9990
| pmid = 22529259
}}</ref>===
'''Observation'''
* Low risk neuroblastoma [[Patient|patients]] younger than 6 months of [[age]] may be safely observed '''without''' obtaining a definitive [[histologic]] [[diagnosis]] or performing any [[Surgery|surgical intervention]].
* [[Observation]] among such [[Patient|patients]] avoids potential [[Complications|surgical complications]], as the majority of neuroblastomas occurring among this [[age]] group demonstrate spontaneous [[regression]].
'''Radiotherapy'''
* [[Radiation therapy|Radiotherapy]] is generally not recommended for the management of low risk neuroblastoma [[Patient|patients]].
 
'''Chemotherapy'''
* Indications for [[chemotherapy]] for the management of low risk neuroblastoma [[Patient|patients]] include:
:* Stage 1 or stage 2 [[Tumor|tumors]] associated with ''MYCN'' [[amplification]]
:* [[Patient|Patients]] older than 18 months of age presenting with a stage 2B tumor and an unfavorable [[histology]]
:* [[Symptomatic]] [[Patient|patients]] due to [[spinal cord]] compression, [[respiratory]] compromise, or [[hepatic]] infiltration
* [[Chemotherapy regimens|Chemotherapeutic regimens]] recommended for the management of low risk neuroblastoma [[Patient|patients]] may include agents such as:
:* [[Carboplatin]]
:* [[Cyclophosphamide]]
:* [[Doxorubicin]]
:* [[Etoposide]]
 
===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><ref>{{Cite journal
| author = [[David L. Baker]], [[Mary L. Schmidt]], [[Susan L. Cohn]], [[John M. Maris]], [[Wendy B. London]], [[Allen Buxton]], [[Daniel Stram]], [[Robert P. Castleberry]], [[Hiroyuki Shimada]], [[Anthony Sandler]], [[Robert C. Shamberger]], [[A. Thomas Look]], [[C. Patrick Reynolds]], [[Robert C. Seeger]] & [[Katherine K. Matthay]]
| title = Outcome after reduced chemotherapy for intermediate-risk neuroblastoma
| journal = [[The New England journal of medicine]]
| volume = 363
| issue = 14
| pages = 1313–1323
| year = 2010
| month = September
| doi = 10.1056/NEJMoa1001527
| pmid = 20879880
}}</ref>===
'''Observation'''
* [[Observation]] is generally not recommended for the management of intermediate risk neuroblastoma [[Patient|patients]].
 
'''Radiotherapy'''
* Indications for [[Radiation therapy|radiotherapy]] for the management of intermediate risk neuroblastoma [[Patient|patients]] include:
:* [[Symptomatic]] life-threatening neuroblastoma refractory to [[chemotherapy]] and/or [[surgery]]
:* Rapidly growing neuroblastoma associated with progressive [[disease]] [[Symptom|symptoms]]
 
'''Chemotherapy'''
* [[Chemotherapeutic agents]] are generally effective for the management of intermediate risk neuroblastoma [[Patient|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 [[Patient|patients]].
* [[Chemotherapy regimens|Chemotherapeutic regimens]] recommended for the management of intermediate risk neuroblastoma [[Patient|patients]] may include agents such as:
:* [[Carboplatin]]
:* [[Cyclophosphamide]]
:* [[Doxorubicin]]
:* [[Etoposide]]
 
===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><ref>{{Cite journal
| author = [[Valeria Smith]] & [[Jennifer Foster]]
| title = High-Risk Neuroblastoma Treatment Review
| journal = [[Children (Basel, Switzerland)]]
| volume = 5
| issue = 9
| year = 2018
| month = August
| doi = 10.3390/children5090114
| pmid = 30154341
}}</ref><ref>{{Cite journal
| author = [[K. Beiske]], [[S. A. Burchill]], [[I. Y. Cheung]], [[E. Hiyama]], [[R. C. Seeger]], [[S. L. Cohn]], [[A. D. J. Pearson]] & [[K. K. Matthay]]
| title = Consensus criteria for sensitive detection of minimal neuroblastoma cells in bone marrow, blood and stem cell preparations by immunocytology and QRT-PCR: recommendations by the International Neuroblastoma Risk Group Task Force
| journal = [[British journal of cancer]]
| volume = 100
| issue = 10
| pages = 1627–1637
| year = 2009
| month = May
| doi = 10.1038/sj.bjc.6605029
| pmid = 19401690
}}</ref>===
'''Observation'''
* [[Observation]] is generally not recommended for the management of high risk neuroblastoma [[Patient|patients]].
'''Radiotherapy'''
* [[Radiation therapy]] to consolidate local control after [[surgical resection]] is recommended for the management of high risk neuroblastoma [[Patient|patients]].
'''Chemotherapy'''
* [[Chemotherapy]] for high risk neuroblastoma [[Patient|patients]] is divided into the following three phases:
:* '''Induction therapy:'''
::* [[Chemotherapy regimens|Chemotherapeutic regimens]] used in the induction therapy may include:
:::* [[Cisplatin]]
:::* [[Etoposide]]
:::* [[Vincristine]]
:::* [[Cyclophosphamide]]
:::* [[Doxorubicin]]
:::* [[Topotecan]]
:* '''Consolidation therapy:'''
::* Consolidation therapy of high risk neuroblastoma [[Patient|patients]] consists of high dose [[chemotherapeutic agents]] administered in tandem with [[hematopoietic stem cell transplantation]].
::* [[Chemotherapy regimens|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 [[Patient|patients]].


==References==
==References==
{{reflist|2}}
{{reflist|1}}


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Latest revision as of 14:21, 5 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]Haytham Allaham, M.D. [3]

Overview

Children oncology group (COG) risk stratification system determines the protocol of management used for neuroblastoma patients. COG risk stratification system divides the patients into 03 groups: low risk, intermediate risk and high risk patients. Low risk neuroblastoma patients are usually managed by either observation or surgical resection of the tumor. Intermediate risk patients are managed by neoadjuvant therapy 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, immunotherapy and isotretrinoin.

Medical Therapy

Risk Stratification[1][2][3][4]


 
 
 
 
 
Children's Oncology Group risk stratification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low risk patients
 
Intermediate risk patients
 
High risk patients
 
 
 
 
 
 
 
 
 


Management of Low Risk Neuroblastoma Patients[5][6][7]

Observation

Radiotherapy

Chemotherapy

Management of Intermediate Risk Neuroblastoma Patients[5][8]

Observation

  • Observation is generally not recommended for the management of intermediate risk neuroblastoma patients.

Radiotherapy

  • Indications for radiotherapy for the management of intermediate risk neuroblastoma patients include:

Chemotherapy

Management of High Risk Neuroblastoma Patients[5][9][10]

Observation

  • Observation is generally not recommended for the management of high risk neuroblastoma patients.

Radiotherapy

Chemotherapy

  • Induction therapy:
  • Consolidation therapy:
  • Maintenance therapy:

References

  1. ↑ Chizuko Okamatsu, Wendy B. London, Arlene Naranjo, Michael D. Hogarty, Julie M. Gastier-Foster, A. Thomas Look, Michael LaQuaglia, John M. Maris, Susan L. Cohn, Katherine K. Matthay, Robert C. Seeger, Tsutomu Saji & Hiroyuki Shimada (2009). "Clinicopathological characteristics of ganglioneuroma and ganglioneuroblastoma: a report from the CCG and COG". Pediatric blood & cancer. 53 (4): 563–569. doi:10.1002/pbc.22106. PMID 19530234. Unknown parameter |month= ignored (help)
  2. ↑ Susan L. Cohn, Andrew D. J. Pearson, Wendy B. London, Tom Monclair, Peter F. Ambros, Garrett M. Brodeur, Andreas Faldum, Barbara Hero, Tomoko Iehara, David Machin, Veronique Mosseri, Thorsten Simon, Alberto Garaventa, Victoria Castel & Katherine K. Matthay (2009). "The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report". Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 27 (2): 289–297. doi:10.1200/JCO.2008.16.6785. PMID 19047291. Unknown parameter |month= ignored (help)
  3. ↑ Chrystal U. Louis & Jason M. Shohet (2015). "Neuroblastoma: molecular pathogenesis and therapy". Annual review of medicine. 66: 49–63. doi:10.1146/annurev-med-011514-023121. PMID 25386934.
  4. ↑ Andrew M. Davidoff (2012). "Neuroblastoma". Seminars in pediatric surgery. 21 (1): 2–14. doi:10.1053/j.sempedsurg.2011.10.009. PMID 22248965. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 5.2 5.3 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
  6. ↑ Jed G. Nuchtern, Wendy B. London, Carol E. Barnewolt, Arlene Naranjo, Patrick W. McGrady, James D. Geiger, Lisa Diller, Mary Lou Schmidt, John M. Maris, Susan L. Cohn & Robert C. Shamberger (2012). "A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study". Annals of surgery. 256 (4): 573–580. doi:10.1097/SLA.0b013e31826cbbbd. PMID 22964741. Unknown parameter |month= ignored (help)
  7. ↑ Douglas R. Strother, Wendy B. London, Mary Lou Schmidt, Garrett M. Brodeur, Hiroyuki Shimada, Paul Thorner, Margaret H. Collins, Edward Tagge, Stanton Adkins, C. Patrick Reynolds, Kevin Murray, Robert S. Lavey, Katherine K. Matthay, Robert Castleberry, John M. Maris & Susan L. Cohn (2012). "Outcome after surgery alone or with restricted use of chemotherapy for patients with low-risk neuroblastoma: results of Children's Oncology Group study P9641". Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 30 (15): 1842–1848. doi:10.1200/JCO.2011.37.9990. PMID 22529259. Unknown parameter |month= ignored (help)
  8. ↑ David L. Baker, Mary L. Schmidt, Susan L. Cohn, John M. Maris, Wendy B. London, Allen Buxton, Daniel Stram, Robert P. Castleberry, Hiroyuki Shimada, Anthony Sandler, Robert C. Shamberger, A. Thomas Look, C. Patrick Reynolds, Robert C. Seeger & Katherine K. Matthay (2010). "Outcome after reduced chemotherapy for intermediate-risk neuroblastoma". The New England journal of medicine. 363 (14): 1313–1323. doi:10.1056/NEJMoa1001527. PMID 20879880. Unknown parameter |month= ignored (help)
  9. ↑ Valeria Smith & Jennifer Foster (2018). "High-Risk Neuroblastoma Treatment Review". Children (Basel, Switzerland). 5 (9). doi:10.3390/children5090114. PMID 30154341. Unknown parameter |month= ignored (help)
  10. ↑ K. Beiske, S. A. Burchill, I. Y. Cheung, E. Hiyama, R. C. Seeger, S. L. Cohn, A. D. J. Pearson & K. K. Matthay (2009). "Consensus criteria for sensitive detection of minimal neuroblastoma cells in bone marrow, blood and stem cell preparations by immunocytology and QRT-PCR: recommendations by the International Neuroblastoma Risk Group Task Force". British journal of cancer. 100 (10): 1627–1637. doi:10.1038/sj.bjc.6605029. PMID 19401690. Unknown parameter |month= ignored (help)


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