Neuroblastoma above 5 Years Old

Neuroblastoma (NB) occurs rarely among 5 years old, and information is scarce on its characteristics and clinical course in this age group. Objective: to investigate the clinical features and outcomes of neuroblastoma (NB) children aged between 5 and 10 years, and to provide a theoretical basis for improving prognosis. Methods: a retrospective analysis was performed for the clinical data of 8 previously untreated NB children, and their clinical features and outcome were analyzed. Results: we collected 8 cases, representing 12.1 % of all patients diagnosed with neuroblastoma in our center. The average age was 7.1 years (between 5 and 10 years). A male predominance was noted: five of the patients. The adrenal location was the most common: 4 of the cases. The average admission time was 1.8 months with extremes between 15 days and 3 months. Clinically five patients were admitted with a poor status and abdominal pain. In 5 of the cases an abdominal mass was found. There was a predominance of advanced stages, 7 patients had metastases at diagnosis. Bone metastases were the most frequent, followed by bone marrow and in 6 patients multiple sites were affected. MIBG was positive in 5/8 patients (62%); Ferritinemia and LDH were elevated in 7 cases, and catecholamine in 5 cases. In the histological study one case corresponded to poorly differentiated and one to differentiated NB. Moreover, 6 tumors were considered undifferentiated. According to the INSS classification our patients were classified all stage IV except one stage III. NMYC was not done in our patients. Partial primary resection of the tumor was possible in one patient. In all other metastatic cases, chemotherapy was initiated according to HR-NBL-MA-10 regimen. Fifty courses of induction have been completed in all except one who was died in the first cure. Four of seven patients undergoing chemotherapy required the palliative treatment for progression of the mass and / or metastases, without the possibility of a surgical cure. The death rate in our series was 50%. One patient died during the first course of vasovagal syncope probably under etoposide, and 3 of the patients under palliative treatment were died with a life expectancy of 2 years on average after diagnosis. The other patients are still under treatment.Conclusion: At the age between 5 and 10 years, the neuroblastoma is associated with a poor prognosis in our series. High dose chemotherapy does not seem to be useful in these patients, hence the need for new therapeutic approaches in this age group.