Does Salvage Chemotherapy Regimen Intensity Embark on Clearance of Bone Marrow Neuroblastoma?

Abstract

Introduction: Neuroblastoma (NBL) is the most common extracranial solid tumor in children. It accounts for 15%<br />of the deaths from cancer in the pediatric age group. Approximately half of the newly diagnosed children are at “high<br />risk" (HR) of treatment failure. This study aim was to evaluate the impact of salvage chemotherapy ICE (ifosfamide,<br />carboplatin, and etoposide) versus TC (topotecan/cyclophosphamide) when administered to NBL HR patients having<br />residual bone marrow disease after primary tumor control on the first line treatment regimen. Materials and Methods:<br />The present retrospective study included two groups of eligible stage 4 NBL patients with persistent bone marrow<br />disease. Group (1), 29 patients, received ICE whereas less intensive TC was administered to Group (2), 32 patients.<br />Data analysis included epidemiological variables, pathology subtype, MYCN gene status, primary tumor response<br />and their correlation with bone marrow disease clearance on each regimen. Results: A higher tendency of complete<br />bone marrow clearance was reported in patients who received ICE compared to TC; 41.4% versus 25.0%, respectively.<br />However, the difference was not statistically significant (p= 0.174). Conclusion: TC regimen appears to be a good<br />alternative to ICE as salvage treatment in an attempt to clear NBL bone marrow residual, with the privilege of being<br />less toxic and can be given on outpatient basis. Further randomized trials of larger study sample size with survival<br />impact analysis are warranted.