Neuroblastoma treatment

What does neuroblastoma look like?

Neuroblastoma metastases look like cyanotic nodules under the skin, neuroblastoma of the neck and mediastinum manifests itself as a thickening of the neck and an increase in the volume of the chest and back.

In retroperitoneal neuroblastoma, the abdominal cavity increases in size, and sometimes a tumor is felt.

What are the standards for the diagnosis of neuroblastoma abroad?

• Ultrasound is a primary diagnostic method, but it allows you to suspect neuroblastoma and make a differential diagnosis with Wilms`s tumor, pheochromocytoma and other rare tumors,
• Then a biopsy is performed, which can be performed abroad with a minimally invasive (laparoscopic or thoracoscopic method), after which the material taken is examined under a microscope,
• In addition, a genetic study is required for amplification of the MYCN gene, deletion of chromosome 1p and mutation of the ALK gene-this determines the prognosis,
• MRI of 3 zones (chest, abdomen and pelvis) with intravenous contrast-in adult patients can be replaced by CT,
• If the process in the bones is suspected, scintigraphy or a method completely unavailable in our countries — scintigraphy with MIBG.

What are the international approaches to the treatment of neuroblastoma

Neuroblastoma is assessed according to the international classification INRG-International Neuroblastoma Risk Group Staging System. According to this classification, the tumor can have stages L1, L2, M, MS, for each of which a different standard of treatment is approved.

Standard of care for the low-risk group:

As a rule, in this case, treatment is limited to surgery. Chemotherapy is carried out only if there has been a progression after the disease.

Standard of treatment for the medium-risk group:

In this case, the operation is performed first, and after 6 blocks of intensive-induction chemotherapy and 4 more blocks of less intensive-the so-called maintenance chemotherapy.

Drugs for induction chemotherapy are doxorubicin, vincristine, and cyclophosphamide, or carboplatatin, etoposide, and vindezine. Cyclophosphamide is used at the stage of maintenance chemotherapy and, possibly, in the form of tablets.

If a relapse occurs after such treatment, then patients over 18 months are prescribed radiation therapy at a dosage of 36 to 40 Gy in parallel with maintenance chemotherapy.

Standard of treatment for high-risk groups:

First, the operation is performed, then 5 months of intensive chemotherapy, then a second operation can be performed if the neuroblastoma could not be completely removed during the intervention. After that, high-dose chemotherapy is again performed and immediately after it, a bone marrow transplant is performed.

After that, the tumor bed is irradiated and immunotherapy with monoclonal antibodies dinutuximab-beta is performed. According to the indications, some patients also receive MIBG therapy and radiation therapy with a radiation dose of up to 36 Gy.

Where is neuroblastoma treated abroad?

The value of the clinic for the treatment of neuroblastoma is determined by the qualification of surgeons and the possibilities for bone marrow transplantation. Israel is the leader in this area — Shiba, Assuta and Ichilov clinics have the best survival rates in the world, along with clinics in the United States and Switzerland. These clinics also have no competitors if the operation requires plastic surgery of nerves or blood vessels.

Also popular in this regard is Turkey-the cost of treatment there is much cheaper than in Israel, and the quality is equal to the European one. Germany, Austria and Spain also provide high-quality medical care, however, there are certain legislative difficulties in organizing the treatment of children in these countries.