Brain metastasis in children with stage 4 neuroblastoma after multidisciplinary treatment
Tóm tắt
Brain metastasis is common in relapsed neuroblastoma patients, but the characteristics of brain metastasis remain largely unknown. This study aimed to investigate the status of brain metastasis with neuroblastoma in South China. In this retrospective case-based study, 106 patients with stage 4 neuroblastoma from the Department of Pediatric Oncology in Sun Yat-sen University Cancer Center between January 2004 and May 2013 were included. The incidence, risk factors, and survival status of these patients were reviewed and analyzed. Of the 106 patients, 11 (10.4%) developed brain metastasis, accounting for 20.0% of 55 patients with relapse or progression. The age at initial diagnosis of the 11 patients ranged from 2 to 10 years (median 4 years), which was younger than that of the patients without brain metastasis (median 5 years, range 1–10 years, P = 0.073). The male to female ratio of the 11 patients was 8:3, which was not significantly different from that of the patients without brain metastasis (P = 0.86). Patients with brain metastasis had higher lactate dehydrogenase levels than those without brain metastasis, but the differences were not significant (P = 0.076). Eight patients died, and 3 patients survived. The median interval from the initial diagnosis to the development of brain metastasis was 18 months (range 6–32 months). The median survival was 4 months (range 1 day to 29 months) after the diagnosis of brain metastasis. The median interval from the manifestation of brain metastasis to death was 3 months (range 1 day to 11 months). High-risk factors for brain metastasis in cases of neuroblastoma include bone marrow involvement and a younger age at initial diagnosis. Nevertheless, multiple treatment modalities can improve disease-free survival.
Tài liệu tham khảo
Zhang F, Sun XF, Li YQ, Zhen ZJ, Zheng HX, Zhu J, et al. Safety of in vitro amplified HLA-haploidentical donor immune cell infusions for childhood malignancies. Chin J Cancer. 2013;32(12):661–6.
Weinstein JL, Katzenstein HM, Cohn SL. Advances in the diagnosis and treatment of neuroblastoma. Oncologist. 2003;8(3):278–92.
Osawa SI, Kumabe T, Saito R, Sonoda Y, Niizuma H, Watanabe M, et al. Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports. Brain Tumor Pathol. 2011;28(2):167–74.
Mazloom A, Louis CU, Nuchtern J, Kim E, Russell H, Allen-Rhoades W, et al. Radiation therapy to the primary and postinduction chemotherapy MIBG-avid sites in high-risk neuroblastoma. Int J Radiat Oncol Biol Phys. 2014;90(4):858–62.
Meany HJ, London WB, Ambros PF, Matthay KK, Monclair T, Simon T, et al. Significance of clinical and biologic features in Stage 3 neuroblastoma: a report from the International Neuroblastoma Risk Group project. Pediatr Blood Cancer. 2014;61(11):1932–9.
Paulino AC, Nguyen TX, Barker JL Jr. Brain metastasis in children with sarcoma, neuroblastoma, and Wilms’ tumor. Int J Radiat Oncol Biol Phys. 2003;57(1):177–83.
Wang J, Zhen ZJ, Liu JC, Liu ZW, Zhu J, Cai Y, et al. The value of primary site radiotherapy in stage 4 high risk neuroblastoma. Zhonghua Fang She Zhong Liu Xue Za Zhi. 2012;21(1):13–5 (in Chinese).
Kramer K, Kushner B, Heller G, Cheng N. Neuroblastoma metastatic to the central nervous system. The Memorial Sloan-Kettering Cancer Center experience and a literature review. Cancer. 2001;91(8):1510–9.
Sidi-Fragandrea V, Hatzipantelis E, Panagopoulou P, Fragandrea I, Anastasiou A, Koliouskas DE. Isolated central nervous system recurrence in a child with stage IV neuroblastoma. Pediatr Hematol Oncol. 2010;27(5):387–92.
Kushner B, Kramer K, Modak S, Kernan NA, Reich LM, Danis K, et al. Topotecan, thiotepa, and carboplatin for neuroblastoma: failure to prevent relapse in the central nervous system. Bone Marrow Transpl. 2006;37(3):271–6.
Choi H, Koh S, Park E, Shin HY, Ahn HS. CNS recurrence following CD34+ peripheral blood stem cell transplantation in stage 4 neuroblastoma. Pediatr Blood Cancer. 2005;45(1):68–71.
Kushner BH, Kramer K, Modak S, Yataghene K, Cheung NK. High-dose cyclophosphamide-irinotecan-vincristine for primary refractory neuroblastoma. Eur J Cancer. 2011;47(1):84–9.
Sun XF, Zhang F, Zhen ZJ, Yang QY, Xia YF, Wu SX, et al. The clinical characteristics and treatment outcome of 57 children and adolescents with primary central nervous system germ cell tumors. Chin J Cancer. 2014;33(8):395–401.
Bagatell R, London WB, Wagner LM, Voss SD, Stewart CF, Maris JM, et al. Phase II study of irinotecan and temozolomide in children with relapsed or refractory neuroblastoma: a Children’s Oncology Group study. J Clin Oncol. 2011;29(2):208–13.
Kramer K, Kushner BH, Modak S, Pandit-Taskar N, Smith-Jones P, Zanzonico P, et al. Compartmental intrathecal radioimmunotherapy: results for treatment for metastatic CNS neuroblastoma. J Neurooncol. 2010;97(3):409–18.