Survival and late effects of comprehensive treatment on children with neuroblastoma

Objective To investigate the organ function survival and late effects and secondary malignancy of childhood neuroblastoma (NB) with high intensity comprehensive treatment. Methods A total of 23 children with NB who received comprehensive treatment in Shanghai Children′s Medical Center from December 1998 to October 2010 were enrolled.All tests were formulated according to the Children′s Oncology Group(COG)′s guidelines with the approval of parents.The late side effects were graded by CTCAE v3.0, and hearing loss related to platinum was graded by Brock and Chang. Results The median follow-up was 96(65-170)months.All the patients had at least one late side effect.The occurrence rate of 1-2 adverse effects was 100%, and 17.4% (4/23 cases) of patients had grade 3-4 adverse effects.90.5% of children (19/21 cases)developed hearing loss on both sides.Eleven children(52.4%, 11/21 cases)developed dental abnormities, comprising microdontia, missing teeth, root stunting and enamel hypoplasia.9.5% of children (2/12 cases)had scoliosis.42.8% of children(9/12 cases) developed hypogonadism with the approval of parents or delayed growth.47.4% of children(9/19 cases)had abnormal respiratory function.36.8% of children (7/19 cases)had abnormal cardiac function.33.4% of children(7/21 cases)developed renal damage.23.8% of children (5/21 cases)had abnormal liver function.66.7% of children (14/21 cases)had low level of cortisol, but adrenocorticotrophic hormone was normal.All children had normal function of thyroid.Three children developed secon-dary malignancy: leukemia, malignant fibroma and liver tumor. Conclusions The incidence of long-term adverse reactions of patients with neuroblastoma treated with high intensity comprehensive treatment is very high and the patients may have adverse effects, like hearing loss, dental abnormality, cardiopulmonary function abnormality, musculoskeletal problems and secondary malignancy.The upmost importance is to establish long-term follow-up program to detect the life quality of children and amend current therapeutic schemes improve life quality. Key words: Neuroblastoma; Long-term adverse reactions; Survival