Clinical features, treatment and prognosis of neuroblastoma with bone metastasis in children

Abstract

Objective To summarize the clinical features of neuroblastoma (NB) with bone metastasis, and preliminarily to analyze the relationship between clinical features, treatment effects and prognosis of NB with bone metastasis and further studying why children with NB would have bone metastasis happened.As such, this paper was seek for more effective therapy to improve patients′survival rates. Methods The retrospective research was carried out to analyze the medical records of 130 patients with bone metastasis of NB from March 2007 to July 2013 who were diagnosed and systematically treated in Beijing Children′s Hospital(BCH) Affiliated to Capital Medical University accor-ding to BCH-NB-2007 protocol.The data were reviewed for the medical history, clinical features and laboratory examination results before treatment.The research evaluated the treatment outcome and overall survival rate of the 88 cases treated and followed up all along at BCH.The deadline for follow-up was December 31, 2014. Results One hundred and thirty children of NB with bone metastasis were included in the research.There were 87 boys and 43 girls; the age was between 8-147 months, the median age was 41 months, 94(72.3%) children′s age was less than 5 years old.The main primary site was retroperitoneal and adrenal region(106 cases, 81.5%) and mediastinum(17 cases, 13.1%). The main clinical symptoms were fever(81 cases, 62.3%), bone pain(51 cases, 39.2%), abdominal pain(29 cases, 22.3%), and abdominal mass(14 cases, 10.8%). A total of 88 cases got systemic treatment and follow-up at BCH.Only 1 infant with NB, at 8 months old with a retroperitoneal mass, with bone marrow and bone metastasis, but no MYCN gene amplification, was given carboplatin plus etoposide and cyclophosvnamide, vincristine and doxorubicin according to European neuroblastoma risk grouping for alternating 8 times, he received tumor resection after 4 courses of chemotherapy and was followed up for 20 months, and the condition was now in stable.The remaining 87 patients as high risk(HR)-NB, were treated regularly by BCH-NB-2007 protocol, with the median follow-up time of 23 months, 52 cases(59.1%) turned out to have tumor progression or relapse.Forty cases died of tumor related diseases and 1 case died of measles infection.The expected overall survival rates were 49.5% in 3 years and 41.3% in 5 years. Conclusions NB with bone metastasis was very common in children over 18 months, and their common clinical symptoms are fever, bone pain and anemia.More than 80% of primary tumor was located in retroperitoneal and adrenal gland area, most of the patients with bone marrow metastasis.Since the overall prognosis is poor in these children, continuous clinical and further study is needed to investigate the causes of bone metastasis in children with NB, and to provide a basis for more effective treatment. Key words: Neuroblastoma; Bone metastasis; Clinical features; Prognosis