Abstract:
Objective To analyze the clinical characteristics and survival rates among children with recurrent neuroblastoma (NB) and to discuss the strategy of salvage treatment.
Methods Recurrent NB cases enrolled between January 2010 and December 2021 at Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine were retrospectively analyzed by means of recurrence type, time to relapse, and initial treatment data. The risk factors for treatment failure were analyzed using survival analysis and a Cox multivariate regression model, and the strategy of salvage treatment was preliminarily evaluated.
Results A total of 43 children with recurrent NB were enrolled in this single-center study. The male-to-female ratio was 2.1:1, and the median ages at the time of initial diagnosis and recurrence were 3.7 (0.7–15.6) years and 5.5 (1.9–17.0) years, respectively. Nine cases had local recurrence and 34 cases had multi-site recurrence, mainly involving the skeleton, lymph nodes, bone marrow, and central nervous system. Among the recurrent cases, one was initially treated in the low-risk group, seven in the medium-risk group, and 35 cases in the high-risk group. The median follow-up time after recurrence was 5.3 years, at which time 17 patients were still alive. The overall 1-year, 3-year, and 5-year survival rates were (76.0±6.4)%, (42.0±7.8)%, and (36.3±7.7)%, respectively. Absence of radiotherapy was a risk factor for local recurrence (HR=2.3; 95%CI: 1.14-3.7). Patients with local recurrence had better outcomes after thorough excision and radiotherapy. The hematological toxicity of the vincristine, irinotecan, and temozolomide (VIT) regimen was significantly lower than that of other salvage chemotherapy regimens.
Conclusions The salvage treatment for recurrent NB in children needs to be comprehensively analyzed according to the recurrence type and initial treatment. The toxicity of VIT regimen is low. The efficacy is comparable to other regimens, and it has a certain value for the salvage treatment of recurrent NB.