Pediatric neuroblastoma with brain metastasis: the prognostic role of surgery

AIM Brain metastasis in pediatric neuroblastoma is uncommon and with poor prognosis. This study was aimed to analyze the prognostic factors and treatment outcomes of neuroblastoma patients with brain metastasis. MATERIAL AND METHODS The medical records of 7 patients with brain metastasis among 120 neuroblastoma patients treated with radiotherapy between June 2002 and December 2018 at our department were collected retrospectively. Survival time and prognostic factors were evaluated. RESULTS The prevalence of brain metastasis was 7/120 (5.8%). The median age was 35 months (25-64). Three (43%) patients had single brain metastasis. Two (29%) patients with solitary metastases underwent gross total resection and 1 (14%) patient with two lesions underwent subtotal resection for brain metastasis. All patients received chemotherapy and radiotherapy. The median time interval between the initial diagnosis and the brain metastasis was 14 months (0-28 months) in all patients; 12 months (0-28 months) in deceased patients and 23 months (19-26 months) in patients who were still alive at the time of this analysis (p=0.245). The median overall survival time after the treatment of brain metastasis was 14 months (7-22 months). Five patients died from progressive disease and 2 patients who had gross total resection were alive for 164 and 187 months, respectively. While the 5-year overall survival rate was 67% in patients with isolated brain metastasis, the 5-year overall survival rate was 0% in the presence of other metastases (p = 0.221). CONCLUSION Isolated brain metastasis and gross total resection of the brain metastasis seems to be favorable prognostic factors. Patients with solitary brain metastasis should be consulted for brain surgery.