OBJECTIVE: To improve the survival of patients with high-risk neuroblastoma.
METHODS: From November 2013 to April 2015 in our hospital treated 13 patients on the protocol of treatment of patients with high-risk neuroblastoma. 4 patients with stage 3 disease, 9 patients with stage 4. The median age at diagnosis was 35.5 (20-92) months. N-myc amplification was detected in 3 patients, 11q23 deletion in 9 patients, 1p36 deletion in 6 patients. 12 patients had metastases to the regional lymph nodes. All 9 patients with stage 4 disease had metastasized into the bone marrow, 8 patients had bone metastases, 2 patients - soft tissue metastases orbits 1 - liver 1 - lungs and 1 - pleural metastases. All patients received induction chemotherapy, surgery, high-dose chemotherapy and radiation therapy. 2 patients with stage 4 disease got MIBG-therapy. Patients with stage 3 disease receiving biological treatment with retinoic acid (Roaccutane) in the consolidation phase. Patients with stage 4 disease, received immunotherapy with dendritic tumor vaccines in the consolidation phase.
RESULTS: 4 patients with stage 3 are alive without evidence of recurrence and disease progression. The observation period of 6 to 21 months. In 4 of the 9 patients with stage IV in the period of 3-6 months from the end of treatment was a relapse of the disease. All of them died after 2-4 months after the detection of recurrent disease (3 from the progression of the disease, one of the complications of antirelapse therapy). 5 of 9 patients with stage IV are alive without evidence of recurrence or progression of the disease, the time of observation of 6-9 months.
CONCLUSIONS: Complex treatment including intensive chemotherapy, surgery, high-dose chemotherapy, radiation therapy, and biotherapy, provides excellent results of treatment of patients with stage III neuroblastoma high risk. Results of treatment of patients with neuroblastoma stage IV high risk remain poor. Research aimed at improving the survival of patients with stage IV neuroblastoma, is a priority.