Treatment results of patients with refractory, relaps or progressional neuroblastom treated between 2005-2018

Objective: Neuroblastoma is the most common extracranial malignant solid tumor in childhood and it is the 3rd most common tumor among all childhood cancers.1 While 5-year overall survival rate is over 90% in low and intermediate risk groups; the 5-year overall survival rate in the high-risk patient group is below 50 %.2 In addition, the mortality rate in diagnosed neuroblastoma cases is 15%, which is still an important cause of mortality in childhood cancers. Therefore, treatment options should be developed to increase survival in neuroblastoma. In this study, it was aimed to investigate the effect of topotecan or ICE + topotecan regimen on survival in high-risk patients and its superiority or difference to other treatment options. Materials and methods: In this study, data of 142 patients diagnosed with neuroblastoma at Çukurova University Medical Faculty Pediatric Oncology Department between 2005 and 2018 were retrospectively accessed from the archive file and the automation system and recorded. Ethics committee approval was obtained. Results: 70 of the patients were girls and 72 were boys. The median age of the patients at the time of diagnosis was 24.5 months, with a mean of 39 ± 40 months. 48.6% (69) of the patients were stage 4. Overall survival rates of all patients were 70% at 3 years, 66% at 5 years, and 62% at 10 years. The overall survival rate of patients diagnosed with 1 year or younger was 87% at 3 years and continued until the 10th year. and significantly higher than other ages (Log rank, p: 0, 008). The patients were evaluated in 4 groups according to their treatment responses. Group I: patients who underwent routine treatment protocol and consisted of 90 patients. The OS rate of Group I was 84% in the 3rd year, 82% in the 5th year, 82% in the 10th year and it was the group with the highest OS in terms of OS. Group II: The patients who started the chemotherapy protocol and added topotecan drug to the treatment protocol (1mg / m2 / dose or 2mg / m2 / dose, 2 doses) as the evaluation result could not be operated, and could be operated later, consisted of 16 patients. The OS rate of Group II was 74% in the 3rd year, 74% in the 5th year and 65% in the 10th year. Group III: Patients with relapse during or after the treatment protocol (operated or not), consisted of 25 (17.6%) patients. 3-year OS was 39%, 5-year OS was 15%, and 10-year OS was 10%. And this group had the lowest rate for OS. Group IV: The treatment protocol was started with biopsy or incomplete resection, could not be operated as a result of the evaluation made and topotecan added to the treatment protocol (1mg / m2 or 2mg / m2, 2 doses) was still unresponsive and no response was obtained despite the treatment protocol was completed. for patients who continued to be treated as ICE-topotecan or died, and consisted of 11 patients. The OS rate for this group was 42% at 3 years and 42% at 5 years. Conclusion: The worst prognosis among neuroblastoma patients belonged to the relapsed group. For this reason, topotecan should be added to the first-line treatment