Treatment of neuroblastoma in Germany
Neuroblastoma is a malignant tumor that is growing of the fetal neuroblasts of the sympathetic nervous system. In 99% it affects children before the age of 15 years. Middle age of the patients is 2 years old.
90% of patients are children before the age of 5 years. Neuroblastoma is the most common oncological illness among the kids before the age of 1 year.
Causes of Neuroblastoma
It remains unknown what are the causes of neuroblastoma. External factors that can increase or decrease the risk of this illnessare not found.
There is a familial form of neuroblastoma observed among 2 % of patients. Familial neuroblastoma is characterized by the primary occurrence of the tumor in two or more locations. Hereditary background impacting the development of other forms of neuroblastoma is not identified.
Neuroblastoma - Symptoms
Neuroblastoma can be located in different parts of the body. Therefore, it is able to cause various clinical symptoms. The most common location of the neoformation are retroperitoneal space (adrenal glands) and the abdominal cavity.
Basic groups of neuroblastoma symptoms are:
Pain. Usually, the tumor is not painful by itself, including on the palpation. But it can reach large sizes and compress the surrounding tissues. As a result, pain syndrome occurs.
Sympathicotonia. Irrespective of the neuroblastoma location, child can have seizures, associated with the increased influence of the sympathetic nervous system on the body. Due to the release of catecholamines and vasoactive intestinal peptidesthe increase in blood pressure, paleness of skin, diarrhea with liquid stools, fever are observed.
Symptoms of vascular compression. Depending on the location of the tumor, child may experience swelling in the legs, scrotum, face, hands, neck, and upper chest. Fluid can accumulate in the pericardium and there will be heart failure symptoms.
Symptoms of nerve compressioncan damage different functions such as:breathing, swallowing, limbs movements (if neuroblastoma is located close to the spine).
Other symptoms depend on the tumor location and the disease prevalence. It can be:
- Cough, hoarsy voice, difficulty breathing if the localization of neuroblastoma is in the chest
- Swollen lymph nodesin presence of metastasis
- Enlarged liver
- Pain in the bones, lameness (neuroblastoma often spreads to the bones)
- Blood-clotting disorder, immunity weakening, anemia if metastasis spread into the bone marrow
Neuroblastoma - Diagnostics
Early diagnosis is difficult because symptoms do not appear at the beginning of the disease.Age of the patient often does not allow him to express complaints of feeling unwell, and even more so to specify them.At the time of the visit to the doctor two-thirds of patients already have metastasis in the lymph nodes.
Following methods are used for the neuroblastoma diagnostics:
Laboratory methods. 85% of patients have the increased levels of catecholamines (to the greatest extent dopamine) in the blood. Diagnostics is held by determining the daily urinary excretion of hormones and their metabolites.
There are also other biochemical markers of neuroblastoma:
- Neuron enolase
Imaging methods. Ultrasound, computed tomography,magnetic resonance imaging, and X-rays are used for the neuroblastoma diagnostics. These methods of diagnostics help to detect the neuroblastoma and its metastasis.
Biopsy is done on the final stage of neuroblastoma diagnostics. With the needle a doctor takes a sample of the tumor mass for cytological and immunohistochemical studies.
Bone marrow puncture is doneto assess the prevalence of the tumor process. Usually, it is done simultaneously with neuroblastoma biopsy while a child is under general anesthesia.
Scintigraphy. Radioactive isotopes are injected into the body. If neuroblastoma is suspected, the MIBG (meta-iodobenzyl guanidine) is used. This material in the chemical structure resembles catecholamines. It accumulates in the tumor cells irrespective of where they are situated. In a few days or hours child’s body is scanned and neuroblastoma location is identified with all its metastasis.
Treatment of Neuroblastoma abroad
Neuroblastoma treatment includes:
- Surgery (tumor resection)
- Radiation therapy
Alternatively to the radiation therapy, in addition to remote irradiation, the MIBG-therapy is used. It presupposes the intravenous injection of the meta-iodobenzyl guanidine. It is a radioactive chemical that accumulates in the tumor cells irrespectively of their location and destroys them.
The procedure is done in the special shielded room. Patient remains completely isolated, as he is radioactive and hazardousduring the treatment period. Isolation lastscouple days.
Patients with the prevalent neuroblastoma forms can be indicated the highly intensive chemotherapy that presupposes the use of high doses of the medications. Taking into consideration the stage of the disease, good results of treatment can be achieved.
Disease-free period is:
- 40% of children - 2 years
- 25% of children - 5 years
- 13% of children - 7 years
Four-year disease-free period can be observed among 30% of patients after the intensive chemotherapy and stem cells transplantation (bone marrow).
The latest (innovative) treatment and diagnostics methods of Neuroblastoma abroad
New ways of neuroblastoma treatment are constantly developed. The medical achievements of the last years are:
Retinoids. The use of retinoids (isotretinoin) can significantly reduce the risk of tumor recurrence.
Targeted therapy is based on the implementation of medications (crizotinib) that influence just the cells with the changed ALK gene. As a result, the tumor is reduced in sizes. ALK gene changes are characteristic for the 15% of neuroblastomas.
Immunotherapy.Monoclonal antibodies (dinutuximab) are used for the neuroblastoma treatment. They stimulate the immune system activity against the tumor cells. Research showed that monoclonal antibodies are effective for some children, who are resistant to chemotherapy.
Neuroblastoma - Prognosis
Prognosis depends on the risk group. Risk group can be low, moderate or high and is determined by the combination of parameters:
- Age (children younger than 1year old have better prognosis)
- Histological type of the neuroblastoma
- Amplification of the MYCN gene (its presence is a bad prognosis sign)
- Change in chromosome 11 (aberration 11q)
- Number of chromosomes in the tumor cells
Five-year survival prognosis, depending on the risk group:
- Low – 95%
- Medium – 90%
- High – 45%
If neuroblastoma was established on the stage 4, the five-year survival is about 20%. In case of the early diagnosis establishment (stage 1) five-year survival is about 100%.
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc