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Treatment of high-risk neuroblastoma: National protocol results of the Turkish Pediatric Oncology Group

1 Department of Pediatric Hematology-Oncology, Ege University Faculty of Medicine, Izmir, Turkey
2 Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
3 Department of Pediatric Hematology, Behcet Uz Training and Research Hospital, Izmir, Turkey
4 Department of Pediatric Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
5 Department of Pediatric Oncology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
6 Department of Pediatric Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
7 Department of Pediatric Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
8 Department of Pediatric Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
9 Department of Pediatric Oncology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
10 Department of Pediatric Oncology, Uludag University Faculty of Medicine, Bursa, Turkey
11 Department of Pediatric Oncology, Ankara University Institute of Oncology, Ankara, Turkey
12 Department of Pediatric Oncology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
13 Department of Pediatric Oncology, Gaziantep University Institute of Oncology, Gaziantep, Turkey
14 Department of Pediatric Oncology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
15 Department of Pediatric Oncology, Tepecik Training and Research Hospital, Izmir, Turkey
16 Department of Pediatric Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
17 Department of Pediatric Oncology, Marmara University Faculty of Medicine, Istanbul, Turkey
18 Department of Pediatric Oncology, Istanbul University Faculty of Medicine, Istanbul, Turkey
19 Department of Pediatric Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
20 Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Turkey
21 Department of Pediatric Oncology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey

Correspondence Address:
Nur Olgun,
Department of Pediatric Oncology, Dokuz Eylul University, Institute of Oncology, Izmir
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Source of Support: None, Conflict of Interest: None

Background:The national protocol aimed to improve the outcome of the high risk neuroblastoma patients by high-dose chemotherapy and stem cell rescue with intensive multimodal therapy. Materials and Methods:After the 6 induction chemotherapy cycles, patients without disease progression were nonrandomly (by physicians' and/or parent's choices) allocated into two treatment arms, which were designed to continue the conventional chemotherapy (CCT), or myeloablative therapy with autologous stem cell rescue (ASCR). Results: Fifty-six percent (272 patients) of patients was evaluated as high risk. Response rate to induction chemotherapy was 71%. Overall event-free survival (EFS) and overall survival (OS) at 5 years were 28% and 36%, respectively. "As treated" analysis documented postinduction EFS of 41% in CCT arm (n = 138) and 29% in ASCR group (n = 47) (P = 0.042); whereas, OS was 45% and 39%, respectively (P = 0.05). Thirty-one patients (11%) died of treatment-related complications. Conclusion: Survival rates of high-risk neuroblastoma have improved in Turkey. Myeloablative chemotherapy with ASCR has not augmented the therapeutic end point in our country's circumstances. The adequate supportive care and the higher patients' compliance are attained, the better survival rates might be obtained in high-risk neuroblastoma patients received myeloablative chemotherapy and ASCR.

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