Long term complications from treatment in survivors of high risk neuroblastoma

Abstract

8543 Background: Few studies have assessed late effects in neuroblastoma (NB) survivors. Methods: 63 high risk NB patients were seen at the Long Term Follow-Up Clinic since 1991. Results: Median age at diagnosis was 3.0 years. 11 patients had stage 3 disease and 52 stage 4 (2 stage 2B initially). Median follow-up was 7.06 years. All patients had surgery and received chemotherapy, 56 (89%) radiation therapy, 38 (60%) immunotherapy and 35 (56%) autologous stem cell transplant. 60 patients (95%) had late effects and 18 (29%) had more than three. The most frequent complications were: hearing loss (62%), primary hypothyroidism (24%), ovarian failure (41% of females), musculoskeletal (21%), pulmonary (19%), neurocognitive (14%), visual (14%), dental (13%) and secondary neoplasms (6%). Grades of severity were: 1 (24%), 2 (44%), 3 (28%) and 4 (4%) (CTCAE v 3.0). Survivors who received cisplatinum were more at risk to develop hearing loss compared to those who did not receive it ( OR, 9.74; 95% CI: 0.9–101.6). A total cyclophosphamide dose greater than 7.4 g was associated with ovarian failure (p=0.02). Pulmonary dysfunction was correlated with chest irradiation (p=0.009). Visual and dental problems were both associated with cranial radiation (p=0.001 and p=0.002 respectively). In a subset of 28 patients who were prepubertal at their first visit, there was a significant correlation between the change in height SDS (−0.28) and the follow-up time (p=0.04). Conclusions: Despite very intensive multimodality treatment, survivors of high-risk NB face relatively moderate late effects. Their early identification and treatment are important for the quality of life of the survivors. No significant financial relationships to disclose.