Article

Prospective trials on neuroblastoma-induced myelopathy are lacking.
Therefore, we retrospectively analysed patients in four national neuroblastoma
trials. METHOD: Neuroblastoma patients diagnosed between August 1989 and December
2008 were included. Clinical and molecular data were available in the national
trials database. Additional details on neurological findings, treatment, and
outcome were collected using a questionnaire. RESULTS: Among 2603 patients, 122
(61 males and 61 females) had symptoms of spinal cord compression (SCC), and 99
of these were included in the final long-term analysis. The survival of patients
with symptoms of SCC was better than that of patients without symptoms. Patients
first presented with lower extremity motor impairment (95%), impaired cutaneous
sensibility (58%), neuropathic pain (56%), bladder dysfunction (44%), and/or
constipation (34%). Symptoms improved after first-line neurosurgery in 36 out of
52 patients and after first line chemotherapy in 30 out of 47 patients (p=0.77).
After a median observation time of 8 years 1 month (range 1mo-19y 6mo), 71 out of
99 patients still had residual impairments: motor impairment (43%), scoliosis
(31%), impaired bladder function (26%), constipation (19%), impaired cutaneous
sensibility (17%), growth delay (14%), and neuropathic pain (5%). The initial
treatment had no clear impact on the frequency of late effects. INTERPRETATION:
This retrospective analysis showed no clear advantage of either first-line
neurosurgery or chemotherapy and that most patients still exhibit residual
symptoms and require specialized care.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS